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