Chirurgie des idiopathischen Makulaforamens: Erfahrungen mit autologem Thrombozytenkonzentrat und Indocyaningrünapplikation

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

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