Subscribe to RSS
Download PDF
DOI: 10.1055/s-2002-36949
Chirurgie des idiopathischen Makulaforamens: Erfahrungen mit autologem Thrombozytenkonzentrat und Indocyaningrünapplikation
Macular Hole Surgery: Experience with Autologous Platelet Concentrate and Indocyanine Green-Assisted Internal Limiting Membrane PeelingHerrn Professor Dr. med. Heinrich Witschel zum 65. Geburtstag gewidmetPublication History
Eingegangen: 7. März 2002
Angenommen: 6. Dezember 2002
Publication Date:
27 January 2003 (online)
Zusammenfassung
Hintergrund: Wir berichten über unsere klinischen Erfahrungen bei der Therapie des idiopathischen Makulaforamens unter Verwendung von autologem Thrombozytenkonzentrat mit und ohne Indocyaningrün (ICG)-gestütztem Peeling der Lamina limitans interna. Patienten und Methoden: Bei 107 Augen von 101 Patienten (m : w = 27 : 74; Durchschnittsalter 60 ± 9, Range 30 - 80 Jahre) mit idiopathischem Makulaforamen der Stadien II - IV nach Gass wurde eine Pars-plana-Vitrektomie, Flüssigkeits-Luft-Austausch und eine Applikation von autologem Thrombozytenkonzentrat durchgeführt. Dabei wurden durchschnittlich 1,9 ± 0,1 × 108 Thrombozyten appliziert. Bei 34 Augen wurde ein Peeling der Lamina limitans interna unternommen, dem in 19 Fällen eine Anfärbung mit ICG vorausgegangen war. Ergebnisse: Die anatomische Erfolgsrate nach Ersteingriff lag im Stadium II (n = 68 Augen) bei 85 %, im Stadium III (n = 27 Augen) bei 75 %, und im Stadium IV (n = 3 Augen) bei 100 %. Über alle Stadien betrug die initiale Verschlussrate 82 %, und der Visus stieg um 1 Zeile an. Nach Reoperation stieg die Verschlussrate auf 96 % an. Die Augen, die ICG-unterstützt operiert worden waren, zeigten keine signifikant verbesserte Verschlussrate (94 %), aber einen signifikant höheren Visusanstieg um durchschnittlich zwei Zeilen. Schlussfolgerungen: Die Applikation von autologem Thrombozytenkonzentrat ist sicher und führt zu einer hohen Lochverschlussrate. Durch ICG-gestütztes Peeling der Lamina limitans interna kann das funktionelle Ergebnis zusätzlich verbessert werden.
Abstract
Backgound: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. Patients and methods: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 ± 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 ± 0,1 × 108 thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. Results: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. Conclusion: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling
Schlüsselwörter
Makulaforamen - autologes Thrombozytenkonzentrat - Indocyaningrün - Lamina limitans interna-Peeling
Key words
Macular hole - autologous platelet concentrate - indocyanine green - internal limiting membrane (ILM) peeling
Literatur
- 1 Banker A S, Freeman W R, Azen S P, Lai M Y. A multicentered clinical study of serum as adjuvant therapy for surgical treatment of macular holes. Vitrectomy for Macular Hole Study Group. Arch Ophthalmol. 1999; 117 (11) 1499-502
- 2 Byhr E, Lindblom B. Macular hole surgery without routine membrane excision or use of adjuvants. Acta Ophthalmol Scand. 2000; 78 (4) 451-455
- 3 Campochiaro P A, Glaser B M. Endothelial cells release a chemoattractant for retinal pigment epithelial cells in vitro. Arch Ophthalmol. 1985; 103 (12) 1876-1880
- 4 Castelnovo L, Dosquet C, Gaudric A, Sahel J, Hicks D. Human platelet suspension stimulates porcine retinal glial proliferation and migration in vitro. Invest Ophthalmol Vis Sci. 2000; 41 (2) 601-609
- 5 Choudhury P, Chen W, Hunt R C. Production of platelet-derived growth factor by interleukin-1 beta and transforming growth factor-beta-stimulated retinal pigment epithelial cells leads to contraction of collagen gels. Invest Ophthalmol Vis Sci. 1997; 38 (5) 824-833
- 6 Cullinane A B, O'Callaghan P, McDermott K, Keohane C, Cleary P E. Effects of autologous platelet concentrate and serum on retinal wound healing in an animal model. Graefe's Archive for Clinical and Experimental Opthalmology. 2002; 240 (1) 35-41
- 7 Da Mata A P, Burk S E, Riemann C D, Rosa R H, Snyder M E, Petersen M R. et al . Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair. Ophthalmology. 2001; 108 (7) 1187-1192
- 8 Engelbrecht N E, Freeman J, Sternberg P, Aaberg T M, Aaberg T M, Martin D F. et al . Retinal pigment epithelial changes after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol. 2002; 133 (1) 89-94
- 9 Ezra E, Aylward W G, Gregor Z J. Membranectomy and autologous serum for the retreatment of full-thickness macular holes. Arch Ophthalmol. 1997; 115 (10) 1276-1280
- 10 Faude F, Edel E, Dannhauer M, Petzel C, Meier P, Wiedemann P. Autologe Thrombozytenapplikation bei der Behandlung des idiopathischen Makulaforamens. Ophthalmologe. 1997; 94 (12) 877-881
- 11 Freeman W R, Azen S P, Kim J W, el-Haig W, Mishell D R, Bailey I. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group. Arch Ophthalmol. 1997; 115 (1) 11-21
- 12 Gamulescu M A, Roider J, Gabel V P. Exudative retinal detachment in macular hole surgery using platelet concentrates - a case report. Graefes Arch Clin Exp Ophthalmol. 2001; 239 (3) 227-229
- 13 Gandorfer A, Haritoglou C, Gass C A, Ulbig M W, Kampik A. Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage. Am J Ophthalmol. 2001; 132 (3) 431-433
- 14 Gandorfer A, Messmer E M, Ulbig M W, Kampik A. Indocyanine green selectively stains the internal limiting membrane. Am J Ophthalmol. 2001; 131 (3) 387-388
- 15 Gass C A, Haritoglou C, Messmer E M, Schaumberger M, Kampik A. Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence. Br J Ophthalmol. 2001; 85 (5) 549-551
- 16 Gass J D. Macular hole opercula: ultrastructural features and clinicopathologic correlation. Arch Ophthalmol. 1998; 116 (7) 965-966
- 17 Gass J DM. Idiopathic senile macular hole: its early stages and pathogenesis. Arch Ophthalmol. 1988; 110 629-639
- 18 Gass J DM. Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol. 1995; 119 752-759
- 19 Gaudric A, Massin P, Paques M, Santiago P Y, Guez J E, Le Gargasson J F. et al . Autologous platelet concentrate for the treatment of full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol. 1995; 233 (9) 549-554
- 20 Gaudric A, Paques M, Massin P, Santiago P Y, Dosquet C. Use of autologous platelet concentrate in macular hole surgery: report of 77 cases. Dev Ophthalmol. 1997; 29 30-35
- 21 Gehring S, Hoerauf H, Laqua H, Kirchner H, Kluter H. Preparation of autologous platelets for the ophthalmologic treatment of macular holes. Transfusion. 1999; 39 (2) 144-148
- 22 Glaser B M, Michels R G, Kuppermann B D, Sjaarda R N, Pena R A. Transforming growth factor-beta 2 for the treatment of full-thickness macular holes. A prospective randomized study. Ophthalmology. 1992; 99 (7) 1162-1172; discussion 1173
- 23 Haritoglou C, Gass C A, Schaumberger M, Gandorfer A, Ulbig M W, Kampik A. Long-term follow-up after macular hole surgery with internal limiting membrane peeling. Am J Ophthalmol. 2002; 134 (5) 661-666
- 24 Johnson R N, Gass J D. Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Ophthalmology. 1988; 95 (7) 917-924
- 25 Kadonosono K, Itoh N, Uchio E, Nakamura S, Ohno S. Staining of Internal Limiting Membrane in Macular Hole Surgery. Arch Ophthalmol. 2000; 118 (8) 1116-1118
- 26 Kang H K, Chang A A, Beaumont P E. The macular hole: report of an Australian surgical series and meta-analysis of the literature. Clin Experiment Ophthalmol. 2000; 28 (4) 298-308
- 27 Kelly N E, Wendel R T. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991; 109 (5) 654-659
- 28 Knapp H. Über die isolierte Zerreißung der Aderhaut infolge von Traumen auf den Augapfel. Arch Augenheilkd. 1869;
- 29 Korobelnik J F, Hannouche D, Belayachi N, Branger M, Guez J E, Hoang-Xuan T. Autologous platelet concentrate as an adjunct in macular hole healing: a pilot study. Ophthalmology. 1996; 103 (4) 590-594
- 30 Kozy D W, Maberley A L. Closure of persistent macular holes with human recombinant transforming growth factor-beta 2. Can J Ophthalmol. 1996; 31 (4) 179-182
- 31 Kusaka S, Hayashi N, Ohji M, Hayashi A, Kamei M, Tano Y. Indocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment. Am J Ophthalmol. 2001; 131 (3) 388-390
- 32 Kusaka S, Sakagami K, Kutsuna M, Ohashi Y. Treatment of full-thickness macular holes with autologous serum. Jpn J Ophthalmol. 1997; 41 (5) 332-338
- 33 Kwok A K, Li W W, Pang C P, Lai T Y, Yam G H, Chan N R. et al . Indocyanine green staining and removal of internal limiting membrane in macular hole surgery: histology and outcome. Am J Ophthalmol. 2001; 132 (2) 178-183
- 34 Lansing M B, Glaser B M, Liss H, Hanham A, Thompson J T, Sjaarda R N. et al . The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular holes. Ophthalmology. 1993; 100 (6) 868-871
- 35 Liggett P E, Skolik D S, Horio B, Saito Y, Alfaro V, Mieler W. Human autologous serum for the treatment of full-thickness macular holes. A preliminary study. Ophthalmology. 1995; 102 (7) 1071-1076
- 36 Margherio A R. Macular hole surgery in 2000. Curr Opin Ophthalmol. 2000; 11 (3) 186-190
- 37 Mester V, Kuhn F. Internal limiting membrane removal in the management of full-thickness macular holes. Am J Ophthalmol. 2000; 129 (6) 769-777
- 38 Minihan M, Goggin M, Cleary P E. Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2. Br J Ophthalmol. 1997; 81 (12) 1073-1079
- 39 Olsen T W, Sternberg P, Capone A, Martin D F, Lim J I, Grossniklaus H E. et al . Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane. Retina. 1998; 18 (4) 322-329
- 40 Paques M, Chastang C, Mathis A, Sahel J, Massin P, Dosquet C. et al . 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 (5) 932-938
- 41 Paques M, Massin P, Blain P, Duquesnoy A S, Gaudric A. Long-term incidence of reopening of macular holes. Ophthalmology. 2000; 107 (4) 760-765; discussion 766
- 42 Peyman G A, Daun M, Greve M D, Yang D, Wafapoor H, Rifai A. Surgical closure of macular hole using an absorbable macular plug. Int Ophthalmol. 1997; 21 (2) 87-91
- 43 Roth D B, Smiddy W E, Feuer W. Vitreous surgery for chronic macular holes. Ophthalmology. 1997; 104 (12) 2047-2052
- 44 Ruby A J, Williams D F, Grand M G, Thomas M A, Meredith T A, Boniuk I. et al . Pars plana vitrectomy for treatment of stage 2 macular holes. Arch Ophthalmol. 1994; 112 (3) 359-364
- 45 Saito Y, Tano Y. Intraoperative adjunctive agents in vitrectomy: serum, cytokines, and glue. Semin Ophthalmol. 2000; 15 (1) 36-43
- 46 Sippy B D, Engelbrecht N E, Hubbard G B, Moriarty S E, Jiang S, Aaberg T M. et al . Indocyanine green effect on cultured human retinal pigment epithelial cells: implication for macular hole surgery. Am J Ophthalmol. 2001; 132 (3) 433-435
- 47 Stalmans P, Parys-Vanginderdeuren R, de Vos R, Feron E J. ICG staining of the inner limiting membrane facilitates its removal during surgery for macular holes and puckers. Bull Soc Belge Ophtalmol. 2001; 281 21-26
- 48 Szurman P, di Tizio F M, Lafaut B, Aisenbrey S, Grisanti S, Roters S. et al . Stellenwert der postoperativen Positionierung in der Chirurgie des idiopathischen Makulaforamens - Kontrollierte konsekutive Studie. Klin Monatsbl Augenheilkd. 2000; 217 (6) 351-355
- 49 Terasaki H, Miyake Y, Nomura R, Piao C H, Hori K, Niwa T. et al . Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery. Invest Ophthalmol Vis Sci. 2001; 42 (1) 229-234
- 50 Thompson J T, Sjaarda R N, Lansing M B. The results of vitreous surgery for chronic macular holes. Retina. 1997; 17 (6) 493-501
- 51 Thompson J T, Smiddy W E, Williams G A, Sjaarda R N, Flynn H W, Margherio R R. et al . Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery. Ophthalmology. 1998; 105 (4) 700-706
- 52 Tingstrom A, Heldin C H, Rubin K. Regulation of fibroblast-mediated collagen gel contraction by platelet- derived growth factor, interleukin-1 alpha and transforming growth factor-beta 1. J Cell Sci. 1992; 102 (Pt 2) 315-322
- 53 Uchihori Y, Puro D G. Mitogenic and chemotactic effects of platelet-derived growth factor on human retinal glial cells. Invest Ophthalmol Vis Sci. 1991; 32 (10) 2689-2695
- 54 Vine A K, Johnson M W. Thrombin in the management of full thickness macular holes. Retina. 1996; 16 (6) 474-478
- 55 Weinberger A W, Kirchhof B, Mazinani B E, Schrage N F. Persistent indocyanine green (ICG) fluorescence 6 weeks after intraocular ICG administration for macular hole surgery. Graefes Arch Clin Exp Ophthalmol. 2001; 239 (5) 388-390
- 56 Wells J A, Gregor Z J. Surgical treatment of full-thickness macular holes using autologous serum. Eye. 1996; 10 (Pt 5) 593-599
Dr. med. Thomas Kube
Augenklinik der Albert-Ludwigs-Universität Freiburg
Killianstraße 5
79106 Freiburg
Email: kube@aug.ukl.uni-freiburg.de