AUTOLOGOUS BLOOD AS ADJUVANT IN INVERTED INTERNAL LIMITING MEMBRANE FLAP SURGERY FOR IDIOPATHIC MACULAR HOLE: CASE SERIES.

PURPOSE: To evaluate the use of autologous blood as an adjuvant in the surgical treatment of idiopathic macular hole associated with the inverted internal limiting membrane flap technique and gas tamponade.

METHODS

Fourteen patients with stage IV idiopathic macular hole and a diameter ≥400 µ m were retrospectively evaluated. All patients underwent 23-gauge pars plana vitrectomy, internal limiting membrane peeling with centripetal inverted flap technique, application of autologous blood over the folded internal limiting membrane flap inside the hole, and tamponade with an air-SF6 (20%) mixture. Patients were instructed to maintain a prone position for 5 days.

RESULTS

Anatomical closure was achieved in all cases. The mean minimum macular hole diameter was 528 µ m. The mean best-corrected visual acuity improved from 20/118 (0.77 logarithm of the minimum angle of resolution units) preoperatively to 20/46 (0.36 logarithm of the minimum angle of resolution units) postoperatively ( P < 0.01). Patients with hole diameters between 400 µ m and 500 µ m improved by 3 to 4 Early Treatment Diabetic Retinopathy Study lines, whereas those with holes >500 µ m improved by 1 to 2 Early Treatment Diabetic Retinopathy Study lines. The mean follow-up duration was 13.2 months (range: 12-24 months). Only one patient developed mild retinal pigment epithelium toxicity related to dye and light exposure.

CONCLUSION

Autologous blood, used as a sealing plug to stabilize the internal limiting membrane flap over the macular hole and as a reservoir of growth factors, proved to be an effective adjuvant in promoting anatomical closure in idiopathic macular hole surgery.