Closure of persistent macular holes with human recombinant transforming growth factor-beta 2

Abstract

Objective: To evaluate the efficacy of human recombinant transforming growth factor-beta 2 (TGF-beta 2) in the closure of persistent macular holes.

Setting: Retina service at a university-affiliated hospital in Vancouver.

Patients: Seventeen patients with macular holes who had previously undergone vitrectomy, posterior cortical vitreous removal and prolonged gas tamponade, with failure to close the hole.

Interventions: Treatment with TGF-beta 2 followed by gas tamponade.

Outcome measure: Closure of macular hole (defined as complete absence of the surrounding neurosensory detachment).

Results: Of the 17 holes 16 (94%) were closed. The average improvement in Snellen acuity was 1.76 lines; nine patients (53%) had at least two lines of improvement. The patients who gained two or more lines of acuity following surgery with TGF-beta 2 had lost significantly more lines of acuity with the primary procedure (p = 0.008) and had worse Snellen acuity following the primary procedure (p = 0.0004) than the patients who gained one line or less of acuity following surgery with TGF-beta 2. Among the patients with a final visual acuity of 20/80 or better the average duration of the hole from the onset of symptoms to the second procedure was 22.2 months.

Conclusions: Treatment with TGF-beta 2 is a potentially useful adjuvant in the closure of persistent macular holes following failed primary surgery.