Human autologous serum for the treatment of full-thickness macular holes. A preliminary study.
BACKGROUND: Recent studies have shown the usefulness of pars plana vitrectomy with/or without the use of transforming growth factor-beta in treating macular holes. The purpose of the present study is to test the efficacy of autologous serum in conjunction with current surgical techniques in the repair of stage 3 or 4 macular holes. METHODS: A total of 11 eyes in nine patients with stage 3 or 4 full-thickness macular holes were treated. The patients ranged in age from 53 to 80 years (mean, 68 years). These patients were followed for 4 to 11 months (mean, 8.4 months). Preoperative best-corrected visual acuity ranged from 2/200 to 20/80 (mean, 20/200). A standardized pars plana vitrectomy was performed with removal of the posterior hyaloid and/or removal of epiretinal membranes, fluid-gas exchange. Autologous serum (0.1 ml) was instilled over the macular hole followed by perfluorocarbon gas tamponade and head positioning for 2 weeks. RESULTS: All 11 (100%) of the eyes in 9 patients had resolution of the surrounding subretinal fluid and flattening of the macular hole. All of the eyes showed an improvement of at least two lines or more (mean, 4.7 lines) in visual acuity. Three eyes (27%) had visual acuities of 20/40 or better, and seven (64%) had visual acuities of 20/60 or better. No exuberant fibrosis proliferation was noted in any eye. CONCLUSION: The results of this preliminary study indicate the possible benefit of autologous serum when used in conjunction with current surgical techniques in treating stage 3 or 4 macular holes.