Autologous platelets for macular hole surgery: the Sussex Eye Hospital experience

Purpose: To evaluate the anatomical and visual outcomes of patients managed by macular hole surgery with adjunctive use of autologous platelets at Sussex Eye Hospital, UK. Methods: A retrospective non-comparative consecutive interventional case series was conducted. Standard macular hole vitrectomy surgery was combined with autologous platelets. No other adjuncts were used, nor internal limiting membrane peeling performed. The main outcome measure was anatomical closure of the macular hole. Secondary outcome measures included: visual outcome (best postoperative best corrected visual acuity [BCVA] and final BCVA), hole reopening and/or re-operation, complications, and time to and influence of cataract surgery. Results: Seventy eyes of 65 patients underwent macular hole surgery with vitrectomy and autologous platelets. There were 14 stage 2 holes, 52 stage 3 holes and four stage 4 holes. Mean follow up was 29 months (range 1.5-78 months). Primary anatomical success (hole closure) was 95.7% (n = 67); however, six (8.5%) holes reopened at a mean of 12.7 months (range 3.6-36.3 months) after their initial surgery. Final surgical success was 98.5% (65/66) in those eyes of patients electing re-operation procedures. Seventy-seven per cent (n = 54) of patients obtained 2 or more lines of visual acuity improvement at final follow up with a mean improvement of 4 lines (range -3 to +12 lines). Forty per cent (n = 28) achieved final BCVA of 6/12 or better, which improved to 51% (n = 36) if best postoperative BCVA was considered. Conclusions: Adjunctive use of autologous platelets at the time of macular hole surgery yields good surgical and visual results, without significant complications, and should remain a considered option in the surgical management of macular holes. Improved macular hole closure with autologous platelets (compared with vitrectomy alone) has previously been demonstrated in a randomized controlled trial. Visual outcome benefit of platelets remains to be investigated by randomized controlled trial and any planned trials should include an autologous platelets intervention arm along with visual acuity as a primary outcome measure.