Lamellar macular holes (LMHs) are partial-thickness defects in the macula observed on spectral-domain optical coherence tomography (SD-OCT). A vitrectomy is the current treatment of choice for LMH, but its reduced efficacy has prompted researchers to search for methods that can improve clinical outcomes.
A recent clinical study evaluated the effectiveness of highly concentrated platelet-rich plasma (PRP) injection combined with a vitrectomy in 8 patients with progressive LMH. The results showed significant improvements of the combination therapy in functional and morphological measures.
A lamellar macular hole (LMH) is a vitreoretinal condition first described in the 1970s as a foveal defect caused by cystoid macular edema after cataract removal. Today, the diagnosis criteria for LMH have been updated as follows:
Most cases of LMH have good prognosis and can be managed conservatively. However, some patients may experience deteriorating vision, prompting the need for treatment.
The standard treatment for LMH is a vitrectomy with removal of epiretinal tissue and the internal limiting membrane (ILM). Unfortunately, unlike full-thickness macular holes or macular pseudoholes, vitrectomies for LMH often result in poor outcomes, especially in advanced degenerative cases.
In 2019, a research team published a small case series involving 3 patients with vitreoretinal interface diseases. All 3 patients were treated by vitrectomy without epiretinal membrane peeling with autologous PRP. Postoperative SD-OCT analyses showed that all patients had LMH closure and visual improvement .
Although the case series only had 3 patients, the positive results warrant further investigation of PRP in LMH surgery.
The present study evaluated 8 eyes in 8 patients with symptomatic and progressive LMH. All patients underwent a vitrectomy with an adjuvant foveal application of highly concentrated PRP.
The patients were assessed for the following measures prior to and following their surgery:
All 8 patients showed significant improvements in all outcomes 3 months following their surgery.
Notably, the preoperative average BCVA corresponded to 20/32 Snellen. Following the vitrectomy, the mean BCVA increased to 20/25 Snellen, a significant improvement in visual acuity . No patient experienced a decline in visual acuity.
In terms of structural outcomes, the SD-OCT showed improved foveal configuration in all cases . The LMH closed completely in two cases.
The favorable results observed may be due to the interaction between PRP components and Muller cells - the principal glial cells of the retina. When the platelets come into contact with the disintegrated fovea, they become activated and release growth factors. This then triggers the proliferation and migration of Muller cells.
Since end-stage LMH shows a pronounced loss of Muller cells, a combination of vitrectomy and PRP application is reasonable in the earlier stages of the condition.
This case series only involved 8 patients, but the results clearly show an advantage of adding PRP to LMH treatment.
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