Plasma rich in growth factors membrane in the treatment of MacTel Type 2 related full thickness macular holes: A Pilot Study

Author: Eduardo Viteri (Ecuador)

Co-authors:

Purpose

To showcase a regenerative approach using plasma rich in growth factors membrane (PRGFm) as a useful adjuvant in surgical treatment of full thickness macular holes (FTMH) associated to macular telangiectasia (MacTel) Type 2

Setting/Venue

Single center institutional vitreoretinal surgery practice

Methods

FTMH is a rare complication in MacTel Type 2 patients that has no definitive treatment. Anatomic closure rates after standard pars plana vitrectomy (PPV) have been reported to be around 25-30% and functional outcomes have a guarded prognosis. PRGFm has been shown to increase tissue regeneration and is used in other atypical or large FTMH with good results. Recent characterization of MacTel Type 2 as a neurodegenerative disorder with secondary vascular changes suggest a role for regenerative modalities. This is an observational consecutive case series report. We reviewed electronic medical records from 2018 to 2021 and included patients with MacTel Type 2 who underwent PPV + PRGFm for FTMH with or without previous surgical interventions. Data was collected for BCVA, Swept Source OCT (SS-OCT) imaging with preoperative macular hole size using minimal diameter (MD), anatomic closure rates and length of follow up. Data was reported qualitatively or using descriptive statistics were appropriate.

Results

103 patients with FTMH were identified of which 7 had concomitant MacTel Type 2 and only 3 eyes were treated with PPV + PRGFm with SS-OCT follow up. One surgeon (JA) performed 2 cases and another (CR) 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

The use of PRFGm appears to be useful and safe as an addition to PPV in the treatment of MacTel Type 2 related FTMH. It can be used safely and provides stimulation for tissue regeneration and closure due to its biological characteristics. The technique is reproducible and does not require complex ILM manipulation. The regenerative properties of PRGFm within this tissue preserving approach could be key in addressing the neurodegenerative component of this disease.