First Author: O.Furashova GERMANY
Co Author(s): S. Wesslau D. Wittig U. Sievert K. Engelmann
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The primary aim was to evaluate the early functional outcome and photoreceptor recovery using autologous platelet concentrate (APC) consequently as a wound healing concept in MH surgery. Secondly, the anatomical results were evaluated.
DESIGN: Retrospective observational case series. PATIENTS: A total of 82 eyes of 82 patients diagnosed with MH stage III or IV, who underwent PPV with MP and APC. Phakic eyes underwent cataract surgery 4 weeks prior to PPV to minimize the operation time and to support tissue recovery. OBSERVATIONS: Patients diagnosed with MH stage III or IV underwent pars plana vitrectomy (PPV) (20 or 23 gauge) with peeling of membrana limitans interna (ILM) and gas endotamponade (C2F6). A mean of 0.4 to 0.5 ml of APC was applied intraoperatively in the region of the macular for 8 minutes after ILM-peeling. Detailed ophthalmologic examination including spectral domain optical coherence tomography (SD-OCT) with analysis of ellipsoid integrity was performed preoperatively (baseline) and 6 weeks after retinal surgery.
20 gauge PPV (20G) was performed in 31 eyes, 23 gauge PPV (23G)in 51 eyes. BCVA was in 23G group statistically significant better (0.74 ± 0.31 LogMAR at baseline vs. 0.42 ± 0.26 LogMAR 6 weeks after surgery; p<0.001). In 20G group there was no statistically significant difference in BCVA (70.81± 0.30 LogMAR at baseline vs. 0.71 ± 0.28 LogMAR 6 weeks after surgery; p=0.124). Postoperative ellipsoid line could be seen as continuous in 15% (12 eyes), disrupted in 52% (62 eyes) and missing in 23% (28 eyes) cases. Integrity of ellipsoid zone correlated directly with functional results. The best visual acuity was achieved in eyes with continuous ellipsoid: 0.57 LogMAR in 20G and 0.38 LogMAR in 23G vs. 0.76 LogMAR and 0.49 LogMAR in eyes with absent ellipsoid. Anatomical success defined as MH closure evaluated on SD-OCT was seen in 83.9% and 94.1% in 20 and 23 gauge-PPV, respectively (p=0.147).
Wound healing effect of APC allows even higher stage MH to improve visual acuity in earlier postoperative phase compared to similar studies and to UK Data Base (Report2, 2013). It could be demonstrated by other authors that visual outcome is directly associated to the recovery of parts of the photoreceptors. Performing 23 gauge sutureless PPV with intraoperative application of APC after ILM-peeling showed superior results with respect to the early restitution of visual function and of anatomical success.