A regenerative approach for a degenerative disease: Plasma rich in growth factors membrane in the treatment of MacTel Type 2 related full thickness macular holes

Author: Eduardo J. Viteri (Colombia)

Co-authors: Juan David Arias, M. Margarita Parra, Carlos M. Rangel, Virgilio Galvis, Martha Ligia Arango

Purpose

Full thickness macular hole (FTMH) associated with macular telangiectasia (MacTel) Type 2 is a vision threatening complication with no definitive treatment and distinctly poor anatomical and functional success rates in comparison with idiopathic FTMH. Our aim is to report the effect of a regenerative approach such as the use of plasma rich in growth factors membrane (PRGFm) in the surgical treatment of this neurodegenerative disease.

Setting/Venue

Single center institutional vitreoretinal surgery practice.

Methods

An educational video demonstrates the preparation and use of PRGFm in the surgical treatment of MacTel Type 2 related FTMH. Three representative cases are shown with preoperative and postoperative swept source OCT (SS-OCT) imaging and data is collected for BCVA, anatomic closure rates and follow up.

Results

An autologous blood sample is obtained on the same day of surgery and centrifuged twice for a total of 22 minutes. The platelet dense, leukocyte free fraction is isolated and then activated by the addition of 10% calcium chloride. It is later incubated at 37 °C to obtain membrane consistency. 3 eyes of 3 patients underwent PPV + PRGFm and follow-up with SS-OCT with one surgeon (JA) performing 2 cases and another (CM) the remaining one. Case 1 was a 63 year-old female with no history of previous surgery with a 677 µm FTMH on his right eye that improved from 20/100 to 20/30 after surgical treatment without internal limiting membrane (ILM) removal. Case 2 was a 72 year-old female with a 628 µm recurrent macular hole on his left eye that improved from counting fingers (CF) vision to 20/300 after treatment with ILM removal. Case 3 was a 70 year-old female presenting with a 624 µm FTMH on his right eye that improved from 20/200 to 20/100 after treatment with ILM removal. Median follow up was 6 months (range 6-18 months), anatomic closure rate was 100% and median LogMar change 0.5 (range 0.3-0.8). No PRGFm related complications were registered

Conlusions

Our series suggests that the addition of PRGFm may improve anatomic results and an overall improvement in vision for patients with MacTel type 2 related FTMH. PRGFm can be used safely and provides a stimulus for tissue regeneration and closure due to its characteristics. The best results were observed in the youngest participant with no previous surgical history and ILM sparing which may add to the hypothesis of a predominant neurodegenerative component rather than a tractional one. Further studies with control groups and randomized allocation are needed to measure the long term effect of this intervention.

Financial Disclosure

Co-author Juan David Arias is a consultant for TOPCON