The Effect of Pars Plana Vitrectomy and Transforming Growth Factor-Beta 2 without Epiretinal Membrane Peeling on Full-thickness Macular Holes

Mary B. Lansing, Bert M. Glaser, Hillary Liss, Ann Hanham, John T. Thompson, Raymond N. Sjaarda, Alan J. Gordon

Research output: Contribution to journalArticle

Abstract

Purpose: Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-β2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results. Methods: A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11–81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-02 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole. Results: Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling. Conclusion: The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-β2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.

Original languageEnglish (US)
Pages (from-to)868-872
Number of pages5
JournalOphthalmology
Volume100
Issue number6
DOIs
StatePublished - Jan 1 1993

ASJC Scopus subject areas

  • Ophthalmology

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