Effect of autologous whole blood in surgery for full-thickness macular hole: a propensity score matching analysis

Idiopathic full-thickness macular hole (FTMH) is a vision-threatening disease treated by the "gold standard" pars planar vitrectomy followed by internal limiting membrane peeling. This conventional surgical approach, while yielding a promising 90% closure rate, has a low success rate in large macular holes. Autologous blood has been proven to significantly enhance the healing process and has been introduced into ophthalmic surgeries. The aim of this study is to compare visual and anatomical outcomes of full-thickness macular holes with and without the use of autologous whole blood.

This retrospective study included 150 patients (150 eyes) diagnosed with FTMH and underwent primary surgery during 2020-2022. Patients with a minimum of 12 months follow-up were divided into whole blood (WB) group (n = 22) and control group (n = 128). An 1:3 propensity score matching (PSM) was performed based on sex, age, cataract history, diabetes, hypertension, injury, minimum linear diameter (MLD), basal diameter (BD) and preoperative best-corrected visual acuity (BCVA). Postoperative BCVA and optical coherence tomography (OCT) findings were collected for postoperative analysis.

After 1:3 PSM, 22 patients in WB group were matched to 66 patients in control group. The demographic characteristics showed no significant difference except for the MLD in WB group being significantly larger than control group: 762.50 ± 353.11 μm compared to 505.91 ± 193.52 μm (p = 0.003). Despite this unfavorable condition, all MHs were closed in the WB group, while in the control group 14 MHs (21.21%) remained open (p < 0.017). The WB group showed significantly better postoperative mean BCVA than control group (p = 0.016). Also, significantly more patients had improvement in BCVA by 0.2 logMAR or more after surgery in the WB group than in the control group (p = 0.05). After surgery with WB, a rugged retinal surface was observed in MHs larger than 1000 μm via OCT imaging.

The incorporation of PSM can greatly reduce the bias incurred by confounders in this retrospective study. The adjuvant use of WB significantly improves the functional and anatomical outcomes after MH surgery. Especially in patients with large MHs, WB can precipitate the proliferation and migration of Müller cells which ensures foveal structure restoration.