Purpose: To evaluate long-term outcome after revitrectomy with autologous platelet concentrate (APC) or whole blood (WB) in persistent idiopathic macular hole (MH) after vitrectomy with internal limiting membrane (ILM) peeling. Procedures: Retrospective study of 75 eyes with persistent MH after vitrectomy with ILM peeling and gas. All patients underwent revitrectomy with gas and APC (n = 61) or WB (n = 14). Main outcome measures were anatomical closure rate and postoperative best-corrected visual acuity (BCVA). Results: Closure rate after revitrectomy was 85.2% (52/61) in the APC group and 7.1% (1/14) in the WB group. Median follow-up was 58 (range 3-147) months. Median BCVA (logMAR) in patients with finally closed MHs was 0.4 ± 0.3. Patients with defects of the ellipsoid zone had significantly worse postoperative BCVA. Morphological MH configuration (atrophic or elevated edges) did not correlate with final closure rate. Conclusions: Revitrectomy with APC and gas is a very effective treatment in persistent MH after vitrectomy with ILM peeling and gas.

1.
García-Layana A, García-Arumí J, Ruiz-Moreno JM, Arias-Barquet L, Cabrera-López F, Figueroa MS: A review of current management of vitreomacular traction and macular hole. J Ophthalmol 2015;2015:809640.
2.
Spiteri CK, Lois N, Scott NW, Burr J, Cook J, Boachie C, Tadayoni R, la Cour M, Christensen U, Kwok AK: Vitrectomy with internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole. Ophthalmology 2014;121:649-655.
3.
Morescalchi F, Costagliola C, Gambicorti E, Duse S, Romano MR, Semeraro F: Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol 2016;62:58-69.
4.
Christensen UC, Kroyer K, Sander B, Larsen M, Henning V, Villumsen J, la Cour M: Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial. Br J Ophthalmol 2009;93:1005-1015.
5.
Lois N, Burr J, Norrie J, Vale L, Cook J, McDonald A, Boachie C, Ternent L, McPherson G; Full-Thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group: Internal limiting membrane peeling versus no peeling for idiopathic full thickness macular hole: a pragmatic randomised controlled trial. Invest Ophthalmol Vis Sci 2011;52:1586-1592.
6.
D'Souza MJ, Chaudhary V, Devenyi R, Kertes PJ, Lam WC: Re-operation of idiopathic full-thickness macular holes after initial surgery with internal limiting membrane peel. Br J Ophthalmol 2011;95:1564-1567.
7.
Moisseiev E, Fabian ID, Moisseiev J, Barak A: Outcomes of repeated pars plana vitrectomy for persistent macular holes. Retina 2013;33:1137-1143.
8.
Cillino S, Cillino G, Ferraro LL, Casuccio A: Treatment of persistently open macular holes with heavy silicone oil (Densiron 68) versus C3F6. A prospective randomized study. Retina 2016;36:688-694.
9.
Rizzo S, Genovesi-Ebert F, Vento A, Cresti F, Miniaci S, Romagnoli MC: Heavy silicone oil (Densiron-68) for the treatment of persistent macular holes: Densiron-68 endotamponade for persistent macular holes. Graefes Arch Clin Exp Ophthalmol 2009;247:1471-1476.
10.
Lappas A, Foerster AM, Kirchhof B: Use of heavy silicone oil (Densiron-68) in the treatment of persistent macular holes. Acta Ophthalmol 2009;87:866-870.
11.
Hillenkamp J, Kraus J, Framme C, Jackson TL, Roider J, Gabel VP, Sachs HG: Retreatment of full-thickness macular hole: predictive value of optical coherence tomography. Br J Ophthalmol 2007;91:1445-1449.
12.
Valldeperas X, Wong D: Is it worth reoperating on macular holes? Ophthalmology 2008;115:158-163.
13.
Dimopoulos S, William A, Voykov B, Ziemssen F, Bartz-Schmidt KU, Spitzer MS: Anatomical and visual outcomes of autologous thrombocyte serum concentrate in the treatment of persistent full-thickness idiopathic macular hole after ILM peeling with brilliant blue G and membrane blue dual. Acta Ophthalmol 2017;95:e429-e430.
14.
Ezra E, Aylward WG, Gregor ZJ: Membranectomy and autologous serum for the retreatment of full-thickness macular holes. Arch Ophthalmol 1997;115:1276-1280.
15.
Pires J, Nadal J, Gomes NL: Internal limiting membrane translocation for refractory macular holes. Br J Ophthalmol 2017;101:377-382.
16.
Chen SN, Yang CM: Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies. Retina 2016;36:163-170.
17.
Szigiato AA, Gilani F, Walsh MK, Mandelcorn ED, Muni RH: Induction of macular detachment for the treatment of persistent or recurrent idiopathic macuar holes. Retina 2016;36:1694-1698.
18.
Paques M, Chastang C, Mathis A, Sahel J, Massin P, Dosquet C, Korobelnik JF, Le Gargasson JF, Gaudric A: Effect of autologous platelet concentrate in surgery for idiopathic macular hole: results of a multicenter, double-masked, randomized trial. Platelets in Macular Hole Surgery Group. Ophthalmology 1999;106:932-938.
19.
Hoerauf H, Kluter H, Joachimmeyer E, Roider J, Framme C, Schlenke P, Kirchner H, Lagua H: Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment. Int Ophthalmol 2001;24:151-159.
20.
Kapoor KG, Khan AN, Tieu BC, Khurshid GS: Revisiting autologous platelets as an adjuvant in macular hole repair: chronic macular holes without prone positioning. Ophthalmic Surg Lasers Imaging 2012;43:291-295.
21.
Gaudric A, Massin P, Paques M, Santiago PY, Guez JE, Le Gargasson JF, Mundler O, Drouet L: Autologous platelet concentrate for the treatment of full thickness macular holes. Graefes Arch Clin Exp Ophthalmol 1995;233:549-554.
22.
Lacci MK, Dardik A: Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med 2010;83:1-9.
23.
Carter MJ, Fylling CP, Parnell LK: Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty 2011;11:e38.
24.
Andia I, Abate M: Platelet-rich plasma: underlying biology and clinical correlates. Regen Med 2013;8:645-658.
25.
Su CY, Kuo YP, Nieh HL, Tseng YH, Burnouf T: Quantitative assessment of the kinetics of growth factors released from platelet gel. Transfusion 2008;48:2414-2420.
26.
Nurden AT, Nurden P, Sanchez M, Andia I, Anitua E: Platelets and wound healing. Front Biosci 2008;13:3532-3548.
27.
Obolenskiy VN, Ermolova DA, Laberko LA, Semenova TV: Efficacy of platelet rich plasma for the treatment of chronic wounds. EWMA J 2014;14:37-41.
28.
Martin P: Wound healing - aiming for perfect skin regeneration. Science 1997;276:75-81.
29.
Kakudo N, Kushida S, Ogura N, Hara T, Suzuki K, Kusomoto K: The use of autologous platelet rich plasma in the treatment of intractable skin ulcer. Open J Reg Med 2012;1:29-32.
30.
Hara S, Sakuraba T, Nakazawa M: Morphological changes of retinal pigment epithelial and glial cells at the site of experimental retinal holes. Graefes Arch Clin Exp Ophthalmol 2000;238:690-695.
31.
Burmeister SL, Hartwig D, Limb GA, Kremling C, Hoerauf H, Müller M, Geerling G: Effect of various platelet preparations on retinal muller cells. Invest Ophthalmol Vis Sci 2009;50:4881-4886.
32.
Velhagen KH, Druegg A, Rieck P: Proliferation and wound healing of retinal pigment epithelium cells in vitro. Effect of human thrombocyte concentrate, serum and PDGF. Ophthalmologe 1999;96:77-81.
33.
Campochiaro PA, Hackett SF, Vinores SA, Freund J, Csaky C, LaRochelle W, Henderer J, Johnson M, Rodriguez IR, Friedman Z: Platelet-derived growth factor is an autocrine growth stimulator in retinal pigmented epithelial cells. J Cell Sci 1994;107:2459-2469.
34.
Kamei M, Kawasaki A, Tano Y: Analysis of extracellular matrix synthesis during wound healing of retinal pigment epithelial cells. Microsc Res Tech 1998;42:311-316.
35.
Purtskhvanidze K, Treumer F, Junge O, Hedderich J, Roider J, Hillenkamp J: The long-term course of functional and anatomical recovery after macular hole surgery. Invest Ophthalmol Vis Sci 2013;54:4882-4891.
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