gms | German Medical Science

A variety of studies proved macular hole surgery successful, with stage and duration of the disease having vital influence on anatomical and visual outcome. Surgery of macular hole stage IV has seldomly been described successful or was often excluded from studies.

During 6/03 - 1/04 only patients with macular holes stage IV were sent to the clinic (n=27). These patients were treated with pars plana vitrectomy, ILM-peeling and long-lasting gas tamponade (C₃F₈) to achieve at least anatomical success. Autologous platelet preparations were used as biological adjuvantium. Compared to former studies, these platelet preparations were applied within 24h after donation, with higher application volumes and prolonged incubation times. Patients were seen at 6 weeks and 6 months post surgery.

At 6 weeks post surgery, 18 of 27 treated patients showed closure of the macular hole, 3 patients had a persisting macular hole, in 5 cases the follow-up data are incomplete up to now, 1 patient developed retinal detachment. Anatomical results exceed visual outcome, although 3 patients achieved vision improvement of ≥2 lines. Nevertheless, more than 50% of the patients reported improvement in the Watzke-Allen slit lamp beam test and Amsler grid test. Results ½ year post surgery are still to be evaluated.

An intensified treatment with platelet preparations as adjuvantium seems to improve at least the anatomical outcome and the subjective experience of the patients after macular hole surgery at stage IV. Despite positive results it is still recommended to see patients at earlier stages and to improve the screening with regard to this disease.