Platelet-rich fibrin membrane packing and air filling in the treatment of refractory macular holes_Chinese Journal of Ocular Fundus Diseases

Authors：

Zeng Siyu ,  Du Lei , Zhao Qiuya , Yang Juan , Xing Yiqiao

Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

Du Lei, Email: du-lei@126.com

Keywords：

Retinal perforations; Vitrectomy; Platelet-rich fibrin; Air

DOI：

10.3760/cma.j.cn511434-20201026-00504

Video：

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Objective To observe and explore the feasibility and effectiveness of platelet-rich fibrin (PRF) membrane packing and air filling in the treatment of refractory macular holes. Methods A retrospective clinical study. From January 2019 to January 2020, 17 patients with refractory macular hole (17 eyes) who diagnosed in Renmin Hospital of Wuhan University were included in the study. Among them, there were 7 males (7 eyes) and 10 females (10 eyes), with the age of 55.18±7.91 years. All eyes underwent 23G minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF packing, and air filling was performed at the end of the operation. The best corrected visual acuity (BCVA) and optical coherence tomography angiography were performed in all eyes before surgery and at 1 week and 1, 3 months after surgery. The BCVA examination was performed using a international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution visual acuity during statistics. Taking 3 months after surgery was as the time point to judge the efficacy, the changes of BCVA, superficial retinal vascular density (SVD), foveal avascular zone (FAZ) area and central foveal thickness (CFT) before and after surgery were compared. Paired t-test was used to compare the indicators before and after surgery. Results Among the 17 eyes, there were 6, 7, and 4 eyes with giant macular hole, high myopia macular hole, and recurrent macular hole, respectively; the hole diameter was 723.94±38.30 μm. Three months after surgery, all holes were closed. Compared with before surgery, the BCVA (t=4.458) and SVD (t=2.675) increased, and the CFT (t=6.329) and FAZ area (t=4.258) decreased at 3 months after surgery, and the differences were statistically significant (P<0.05). At the last follow-up, there was no complications such as intraocular hypertension and retinal detachment in all eyes.Conclusion Minimally invasive vitrectomy combined with internal limiting membrane stripping and PRF tamponade in the treatment of refractory macular holes can increase the closure rate, improve visual acuity and retinal blood perfusion.

Citation： Zeng Siyu, Du Lei, Zhao Qiuya, Yang Juan, Xing Yiqiao. Platelet-rich fibrin membrane packing and air filling in the treatment of refractory macular holes. Chinese Journal of Ocular Fundus Diseases, 2022, 38(4): 285-288. doi: 10.3760/cma.j.cn511434-20201026-00504 Copy

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2.	Wu T, Kung Y. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3): 327-331. DOI: 10.1007/s00417-011-1821-7.
3.	赵培泉, 吕骄. 玻璃体切割手术治疗难治性黄斑裂孔的手术策略[J]. 中华眼底病杂志, 2020, 36(7): 495-498. DOI: 10.3760/cma.j.cn511434-20200622-00301.Zhao PQ, Lyu J. The surgical strategy of vitrectomy for refractory macular hole[J]. Chin J Ocul Fundus Dis, 2020, 36(7): 495-498. DOI: 10.3760/cma.j.cn511434-20200622-00301.
4.	Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part Ⅰ: Technological concepts and evolution[J/OL]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(3): e37-e44[2006-01-19]. https://pubmed.ncbi.nlm.nih.gov/16504849/. DOI: 10.1016/j.tripleo.2005.07.008.
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6.	Bringmann A, Unterlauft JD, Wiedemann R, et al. Two different populations of Müller cells stabilize the structure of the fovea: an optical coherence tomography study[J]. Int Ophthalmol, 2020, 40(11): 2931-2948. DOI: 10.1007/s10792-020-01477-3.
7.	Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial[J]. BMC Ophthalmol, 2018, 18(1): 177. DOI: 10.1186/s12886-018-0826-y.
8.	Ittarat M, Somkijrungroj H, Chansangpetch S, et al. Literature review of surgical treatment in idiopathic full-thickness macular hole[J]. Clin Ophthalmol, 2020, 14: 2171-2183. DOI: 10.2147/OPTH.S262877.
9.	Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)[J]. Trends Biotechnol, 2009, 27(3): 158-167. DOI: 10.1016/j.tibtech.2008.11.009.
10.	Koytak A, Nuhoglu F, Bayraktar H, et al. Autologous platelet-rich fibrin in the treatment of refractory macular holes[J/OL]. Case Rep Ophthalmol Med, 2019, 2019: 6054215[2019-11-06]. https://pubmed.ncbi.nlm.nih.gov/31781448/. DOI: 10.1155/2019/6054215.
11.	Wilczyński T, Heinke A, Niedzielska-Krycia A, et al. Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment[J]. Clin Interv Aging, 2019, 14: 505-514. DOI: 10.2147/CIA.S189417.
12.	Akahori T, Iwase T, Yamamoto K, et al. Macular displacement after vitrectomy in eyes with idiopathic macular hole determined by optical coherence tomography angiography[J]. Am J Ophthalmol, 2018, 189: 111-121. DOI: 10.1016/j.ajo.2018.02.021.
13.	Baba T, Kakisu M, Nizawa T, et al. Supericial foveal avascular zone determined by optical coherence tomography angiography before and after macular hole surgery[J]. Retina, 2017, 37(3): 444-450. DOI: 10.1097/IAE.0000000000001205.
14.	Tyagi M, Basu S. Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): a novel surgical technique for closing retinal breaks[J]. Indian J Ophthalmol, 2019, 67(5): 677-680. DOI: 10.4103/ijo.IJO_1943_18.
15.	Anshuman K, Ratra D. Commentary: fibrin glue in rhegmatogenous retinal detachment repair-are we there yet?[J]. Indian J Ophthalmol, 2019, 67(5): 683-684. DOI: 10.4103/ijo.IJO_104_19.
16.	Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part Ⅳ: clinical effects on tissue healing[J/OL]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(3): e56-e60[2006-02-28]. https://pubmed.ncbi.nlm.nih.gov/16504852/. DOI: 10.1016/j.tripleo.2005.07.011.
17.	Figueroa MS, Govetto A, de Arriba-Palomero P. Short-term results of platelet-rich plasma as adjuvant to 23-G vitrectomy in the treatment of high myopic macular holes[J]. Eur J Ophthalmol, 2016, 26(5): 491-496. DOI: 10.5301/ejo.5000729.

1. Teng Y, Yu M, Wang Y, et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(5): 893-902. DOI: 10.1007/s00417-017-3586-0.
2. Wu T, Kung Y. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3): 327-331. DOI: 10.1007/s00417-011-1821-7.
3. 赵培泉, 吕骄. 玻璃体切割手术治疗难治性黄斑裂孔的手术策略[J]. 中华眼底病杂志, 2020, 36(7): 495-498. DOI: 10.3760/cma.j.cn511434-20200622-00301.Zhao PQ, Lyu J. The surgical strategy of vitrectomy for refractory macular hole[J]. Chin J Ocul Fundus Dis, 2020, 36(7): 495-498. DOI: 10.3760/cma.j.cn511434-20200622-00301.
4. Dohan DM, Choukroun J, Diss A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part Ⅰ: Technological concepts and evolution[J/OL]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(3): e37-e44[2006-01-19]. https://pubmed.ncbi.nlm.nih.gov/16504849/. DOI: 10.1016/j.tripleo.2005.07.008.
5. Morescalchi F, Costagliola C, Gambicorti E, et al. Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery[J]. Surv Ophthalmol, 2017, 62(1): 58-69. DOI: 10.1016/j.survophthal.2016.07.003.
6. Bringmann A, Unterlauft JD, Wiedemann R, et al. Two different populations of Müller cells stabilize the structure of the fovea: an optical coherence tomography study[J]. Int Ophthalmol, 2020, 40(11): 2931-2948. DOI: 10.1007/s10792-020-01477-3.
7. Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial[J]. BMC Ophthalmol, 2018, 18(1): 177. DOI: 10.1186/s12886-018-0826-y.
8. Ittarat M, Somkijrungroj H, Chansangpetch S, et al. Literature review of surgical treatment in idiopathic full-thickness macular hole[J]. Clin Ophthalmol, 2020, 14: 2171-2183. DOI: 10.2147/OPTH.S262877.
9. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)[J]. Trends Biotechnol, 2009, 27(3): 158-167. DOI: 10.1016/j.tibtech.2008.11.009.
10. Koytak A, Nuhoglu F, Bayraktar H, et al. Autologous platelet-rich fibrin in the treatment of refractory macular holes[J/OL]. Case Rep Ophthalmol Med, 2019, 2019: 6054215[2019-11-06]. https://pubmed.ncbi.nlm.nih.gov/31781448/. DOI: 10.1155/2019/6054215.
11. Wilczyński T, Heinke A, Niedzielska-Krycia A, et al. Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment[J]. Clin Interv Aging, 2019, 14: 505-514. DOI: 10.2147/CIA.S189417.
12. Akahori T, Iwase T, Yamamoto K, et al. Macular displacement after vitrectomy in eyes with idiopathic macular hole determined by optical coherence tomography angiography[J]. Am J Ophthalmol, 2018, 189: 111-121. DOI: 10.1016/j.ajo.2018.02.021.
13. Baba T, Kakisu M, Nizawa T, et al. Supericial foveal avascular zone determined by optical coherence tomography angiography before and after macular hole surgery[J]. Retina, 2017, 37(3): 444-450. DOI: 10.1097/IAE.0000000000001205.
14. Tyagi M, Basu S. Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): a novel surgical technique for closing retinal breaks[J]. Indian J Ophthalmol, 2019, 67(5): 677-680. DOI: 10.4103/ijo.IJO_1943_18.
15. Anshuman K, Ratra D. Commentary: fibrin glue in rhegmatogenous retinal detachment repair-are we there yet?[J]. Indian J Ophthalmol, 2019, 67(5): 683-684. DOI: 10.4103/ijo.IJO_104_19.
16. Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part Ⅳ: clinical effects on tissue healing[J/OL]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(3): e56-e60[2006-02-28]. https://pubmed.ncbi.nlm.nih.gov/16504852/. DOI: 10.1016/j.tripleo.2005.07.011.
17. Figueroa MS, Govetto A, de Arriba-Palomero P. Short-term results of platelet-rich plasma as adjuvant to 23-G vitrectomy in the treatment of high myopic macular holes[J]. Eur J Ophthalmol, 2016, 26(5): 491-496. DOI: 10.5301/ejo.5000729.

Chinese Journal of Ocular Fundus Diseases

Platelet-rich fibrin membrane packing and air filling in the treatment of refractory macular holes

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