Blood-Assisted Internal Limiting Membrane Peeling for Macular Hole Repair
Presented at: Ophthalmological Society of Taiwan Annual Meeting, Taipei City, Taiwan; Taipei International Symposium on Current Ophthalmology, December 2007, Taipei, Taiwan; and International Advanced Vitreoretinal Course, January 2008, Kuala Lumpur, Malaysia.
Received 13 March 2008; received in revised form 23 January 2009; accepted 25 February 2009. published online 05 June 2009.
Purpose
To evaluate the efficacy of autologous heparinized whole blood in assisting internal limiting membrane (ILM) peeling by coating the ILM for macular hole (MH) repair.
Design
Prospective, interventional case series.
Participants
Twenty-nine patients (32 eyes) who underwent blood-assisted ILM peeling for MH repair.
Methods
Patients in whom stage 2–4 idiopathic MHs had developed and who desired surgery were enrolled in this study. After core vitrectomy, autologous heparinized whole blood was applied to cover the macula and to coat the surface of the macular area in the fluid-filled vitreous cavity. The redundant blood was removed and only a very thin film of blood was left on the macular area. The blood-coated ILM was removed by forceps in a circular fashion. To confirm the removed membrane was the ILM, the first 10 specimens were examined by electron microscopy (EM).
Main Outcome Measures
The MH closure rate, the interval mean visual acuity (before and after surgery), retinal changes, and the EM results of the ILM specimens.
Results
All 32 eyes in 29 patients completed 12 months of follow-up. The ILM were coated by autologous heparinized whole blood, removed without difficulty, and confirmed by EM. The whole blood highlighted the contrast of the coated and noncoated areas during the ILM peeling procedure. The MHs were closed in all surgical eyes with a single surgery (100%). Compared with study entry, the mean logMAR best-corrected visual acuity 12 months after surgery improved significantly (1.02 and 0.53, respectively; P<0.001). At 12 months of follow-up, 31 eyes (96.9%) had stable or improved vision. No toxic fundus changes were observed during follow-up.
Conclusions
Autologous heparinized whole blood coated the ILM and facilitated visibility during ILM peeling. Autologous heparinized whole blood is a cost-effective and useful tool for assisting MH surgery.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: June 5, 2009.
1Department of Ophthalmology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
2Department of Ophthalmology, Chang-Gung Memorial Hospital, Keelung, Taiwan
3Chang Gung University College of Medicine, Kuei-Shan Township, Taoyuan County, Taiwan
Correspondence: Chi-Chun Lai, MD, Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kwei-Shan, 333 Taoyuan, Taiwan
Manuscript no. 2008-339.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported in part by the National Science Council of Taiwan (grant no.: NMRPG450061), Taipei City, Taiwan.
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