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. 2020 Nov 18;13(11):1773-1779.
doi: 10.18240/ijo.2020.11.14. eCollection 2020.

Parafoveal retinal massage combined with autologous blood cover in the management of giant, persistent or recurrent macular holes

Hua Wang  1   2 , Meng Ji  1   2 , Rong Di  1 , Yun Qi  1 , Cheng Pei  1 , Shan Gao  1 , Si-Wei Liu  1 , An-Ming Xie  1 , Yu-Hong Cheng  1
Affiliations

Parafoveal retinal massage combined with autologous blood cover in the management of giant, persistent or recurrent macular holes

Hua Wang et al. Int J Ophthalmol. .

Abstract

Aim: To assess the efficacy and safety of parafoveal retinal massage combined with autologous whole blood cover in the treatment of refractory macular holes (MHs) and present the surgical procedure.

Methods: Patients with giant (minimum diameter ≥800 µm), recurrent or persistent MHs who underwent PPV combined with parafoveal retinal massage and autologous whole blood cover using C3F8 as tamponade agent from February 2018 to May 2019 were enrolled in this retrospective study. After surgery, all patients were informed to maintain a prone position for at least 7d. Preoperative and postoperative best-corrected visual acuities (BCVAs) were compared and MH closure rate was measured as the main outcome.

Results: A total of 13 MH patients consisted of 6 giant MHs, 4 persistent holes and 3 recurrent holes (5 men and 8 women; average age was 56.40±11.72y) were enrolled in this study. MH closure was achieved in 11 eyes by this modified surgical technique while 2 eyes failed. Revitrectomy with autologous neurosensory retinal patch transplantations was applied for those 2 patients and then both holes were closed. No intraoperative complications were observed. BCVA improved from 1.73 logMAR to 0.74 logMAR at 6mo postoperation. There was significant difference in BCVA before versus after the surgery (P<0.05). There were no adverse events occurred during the follow-up period.

Conclusion: With easier surgical procedure, parafoveal retinal massage combined with autologous whole blood cover is an effective addition to the surgical options for the management of refractory MHs.

Keywords: autologous blood cover; giant macular hole; parafoveal retinal massage; persistent macular hole; recurrent macular hole; vitrectomy.

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Figures

Figure 1
Figure 1. The patient who suffered with rhegmatogenous retinal detachment primary with macular hole (diameter=341 µm, right eye) had underwent previous vitreoretinal surgeries twice. The first surgery was vitrectomy and ILM peeling with silicone oil for tamponade, and then the hole closed. Following silicone oil extraction combined with phacoemulsification and IOL implantation was performed 6mo later. However, recurrent macular hole with diameter of 818 µm was discovered at 1wk after the second surgery
A: Triamcinolone acetonide was used for staining and identifying whether there was residual vitreous gel; B: Little left ILM could be seen by indocyanine green staining; C: The flute needle was put onto the hole edge to make a cuff of MH with passive suction and slightly blow; D: Gently massage on the parafoveal retina toward the center with vit probe; E: Autologous whole blood was injected into vitreous cavity and the macular hole was fully covered; F: Thorough fluid-air exchange was performed to drain off the liquid of vitreous cavity.
Figure 2
Figure 2. Part of the MHs status before and after surgery showed by SD-OCT.
Figure 3
Figure 3. SD-OCT showed status of the 2 initially failed holes before and after surgery.
See this image and copyright information in PMC

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