Surgical treatment of full-thickness macular holes using autologous serum

Full-thickness macular holes (FTMH) are an important cause of visual loss in older patients. Recognition of tangential vitreofoveal traction as the mechanism of hole formation has led to the use of vitrectomy and gas tamponade as a treatment for macular holes. The use of growth factors as an adjunctive therapy to promote chorioretinal adhesion and hole closure has also been advocated.

Forty-four consecutive patients undergoing vitrectomy, posterior hyaloid removal, gas injection and installation of autologous serum for FTMH were studied prospectively. Patients' age, sex, duration of symptoms, best corrected pre- and post-operative Snellen visual acuities, best corrected acuity in the fellow eye, stage of macular hole, post-operative closure or persistence of the macular hole, and intra- and post-operative complications were recorded.

Of 43 patients with adequate follow-up (minimum 6 weeks, mean 6.1 months) anatomical closure of the macular hole was achieved in 29 eyes (67%). The average visual improvement in these eyes was 2.7 lines. Twenty eyes (69%) with closed holes had visual acuity of 6/12 or better (47% of all patients undergoing surgery). Of the 14 eyes (33%) that failed, the average loss of vision was 0.4 lines and all these eyes had vision of 6/36 or worse.

In this series, surgical treatment of FTMH with vitrectomy, gas injection and autologous serum resulted in closure of the macular hole in two-thirds of patients and restored central vision in about one-half of patients. These results compare favourably with previously reported results of macular hole surgery. The answer to the question whether the use of autologous serum leads to a higher closure rate than surgery with gas tamponade alone requires information from randomised treatment trials, one of which is currently in progress.