Chirurgie des idiopathischen Makulaforamens: Erfahrungen mit autologem Thrombozytenkonzentrat und Indocyaningrünapplikation

Thomas Kube; Martin Hermel; Claudia Dahlke; Gabriele Hutschenreuter; Norbert Schrage; Bernd Kirchhof

doi:10.1055/s-2002-36949

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2002; 219(12): 883-888
DOI: 10.1055/s-2002-36949

Klinische Studie

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 PeelingThomas Kube^1, ² , Martin Hermel² , Claudia Dahlke² , Gabriele Hutschenreuter³ , Norbert Schrage² , Bernd Kirchhof^1, ⁴

¹Augenklinik der Albert-Ludwigs-Universität Freiburg, Freiburg (komm. Direktor: Prof. Dr. med. Dr. rer. nat. J. Funk)
²Augenklinik der RWTH Aachen, Aachen (Komm. Direktor: PD Dr. med. N. Schrage)
³Institut für Transfusionsmedizin der RWTH Aachen, Aachen (Direktor: Dr. med. G. Hutschenreuter)
⁴Zentrum für Augenheilkunde der Universität zu Köln, Abteilung für Netzhaut- und Glaskörper-Chirurgie, Köln (Direktor: Prof. Dr. med. B. Kirchhof)

Herrn Professor Dr. med. Heinrich Witschel zum 65. Geburtstag gewidmet

Abstract

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

Full Text

References

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