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VOLUME 16 , ISSUE 1 ( February, 2023 ) > List of Articles

Técnica de Cierre de Agujero Macular Grande sin Pelado de Membrana Limitante Interna con Membrana de Plasma Rico en Factores de Crecimiento

Juan D. Arias, Carlos M. Córdoba-Ortega, Dayron F. Martinez-Pulgarin, Carlos M. Rangel, Martha L. Arango-Rodríguez

Keywords : Agujero macular, PRGFm, MLI, VPP

Citation Information : Arias JD, Córdoba-Ortega CM, Martinez-Pulgarin DF, Rangel CM, Arango-Rodríguez ML. Técnica de Cierre de Agujero Macular Grande sin Pelado de Membrana Limitante Interna con Membrana de Plasma Rico en Factores de Crecimiento. 2023; 16 (1):23-31.

DOI: 10.5005/hov-10102-16102

Published Online: 16-02-2023

Copyright Statement:  Copyright © 2023; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

El agujero macular (AM) es un reto para los cirujanos de retina. Existen técnicas quirúrgicas descritas para lograr el cierre del AM. La vitrectomía pars plana (VPP) con pelado de la membrana limitante interna (MLI) ha permitido conseguir el cierre en más del 90% de los casos. Sin embargo, en los AM grandes (más de 400 micras), y en agujeros maculares secundarios no presentan el mismo éxito y la tasa de cierre disminuye hasta un rango de 4% a 87.5%. Se han descrito diferentes técnicas como colgajos de MLI invertidos o adyuvantes como membrana amniótica, injerto de retina autólogo e inyección de líquido en el espacio subretiniano para favorecer la aproximación del borde del agujero macular mejorando las tasas de éxito anatómico de todos los tipos de agujero macular. Estas técnicas han tenido buen resultado anatómico, pero con poca o nula recuperación visual por lo cual no existe un adecuado proceso regenerativo de la retina. El plasma rico en factores de crecimiento (PRGF, por sus siglas en inglés) es una nueva terapia autóloga que contiene múltiples agentes biológicos activos, incluidos el factor de crecimiento epidérmico (EGF, por sus siglas en inglés), el factor de crecimiento derivado de las plaquetas (PDGF, por sus siglas en inglés), el factor de crecimiento insulínico (IGF, por sus siglas en inglés) y el factor neurotrófico (NGF, por sus siglas en inglés). El PRGF posee potencial de regeneración tisular, modulación de la cicatrización y efectos antiinflamatorios. En forma de membrana tiene propiedades mecánicas y biológicas para aplicación intraocular. Queremos mostrar un enfoque regenerativo utilizando la membrana de PRGF como un adyuvante útil en el tratamiento quirúrgico con preservación de la MLI para evitar el defecto ya conocido de disociación de la capa de fibras nerviosas (DONFL, por sus siglas en inglés) y defectos en la capa de células ganglionares. Tenemos amplia experiencia en el tratamiento de AM con esta terapéutica y hemos obtenido excelentes resultados anatómicos y funcionales perdurables en el tiempo.


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  1. ChKelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol [Internet]. 1991 [cited 2023 Jan 11];109(5):654–9. Available from: https://pubmed.ncbi.nlm.nih.gov/2025167/
  2. Kang SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications. Br J Ophthalmol [Internet]. 2003 Aug 1 [cited 2023 Jan 11];87(8):1015–9. Available from: https://pubmed.ncbi.nlm.nih.gov/12881347/
  3. Purtskhvanidze K, Frühsorger B, Bartsch S, Hedderich J, Roider J, Treumer F. Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood. Ophthalmologica [Internet]. 2018 Dec 1 [cited 2023 Jan 11];239(1):19–26. Available from: https://pubmed.ncbi.nlm.nih.gov/29050013/
  4. Ito Y, Terasaki H, Takahashi A, Yamakoshi T, Kondo M, Nakamura M. Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes. Ophthalmology [Internet]. 2005 Aug [cited 2023 Jan 11];112(8):1415–20. Available from: https://pubmed.ncbi.nlm.nih.gov/16061095/
  5. Tadayoni R, Svorenova I, Erginay A, Gaudric A, Massin P. Decreased retinal sensitivity after internal limiting membrane peeling for macular hole surgery. Br J Ophthalmol [Internet]. 2012 Dec [cited 2023 Jan 11];96(12):1513–6. Available from: https://pubmed.ncbi.nlm.nih.gov/23077227/
  6. Eckardt C, Eckardt U, Groos S, Luciano L, Reale E. [Removal of the internal limiting membrane in macular holes. Clinical and morphological findings]. Ophthalmologe [Internet]. 1997 [cited 2023 Jan 10];94(8):545–51. Available from: https://pubmed.ncbi.nlm.nih.gov/9376691/
  7. Mohammed O, Pai A. New Surgical Technique for Management of Recurrent Macular Hole. Middle East Afr J Ophthalmol [Internet]. 2017 Jan 1 [cited 2023 Jan 10];24(1):61–3. Available from: https://pubmed.ncbi.nlm.nih.gov/28546696/
  8. Parravano M, Giansanti F, Eandi CM, Yap YC, Rizzo S, Virgili G. Vitrectomy for idiopathic macular hole (Review). 2015 [cited 2023 Jan 10]; Available from: http://www.thecochranelibrary.com
  9. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology [Internet]. 2013 Dec [cited 2023 Jan 10];120(12):2611–9. Available from: https://pubmed.ncbi.nlm.nih.gov/24053995/
  10. Matsumiya W, Kusuhara S, Shimoyama T, Honda S, Tsukahara Y, Negi A. Predictive value of preoperative optical coherence tomography for visual outcome following macular hole surgery: Effects of imaging alignment. Jpn J Ophthalmol [Internet]. 2013 May 27 [cited 2023 Jan 10];57(3):308–15. Available from: https://link.springer.com/article/10.1007/s10384-013-0232-1
  11. Figueroa MS, Mora Cantallops A, Virgili G, Govetto A. Long-term results of autologous plasma as adjuvant to pars plana vitrectomy in the treatment of high myopic full-thickness macular holes. Eur J Ophthalmol [Internet]. 2021 Sep 1 [cited 2023 Jan 10];31(5):2612–20. Available from: https://journals.sagepub.com/doi/full/10.1177/1120672120960340
  12. Fung NSK, Mak AKH, Yiu R, Wong IYH, Lam WC. Treatment of large, chronic and persistent macular hole with internal limiting membrane transposition and tuck technique. Int J Retina Vitreous [Internet]. 2020 Feb 4 [cited 2023 Jan 10];6(1). Available from: https://pubmed.ncbi.nlm.nih.gov/32180996/
  13. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol [Internet]. 1991 [cited 2023 Jan 10];109(5):654–9. Available from: https://pubmed.ncbi.nlm.nih.gov/2025167/
  14. Michalewska Z, Michalewski J, Dulczewska-Cichecka K, Adelman RA, Nawrocki J. Temporal Inverted Internal Limiting Membrane Flap Technique Versus Classic Inverted Internal Limiting Membrane Flap Technique: A Comparative Study. Retina [Internet]. 2015 Sep 16 [cited 2023 Jan 10];35(9):1844–50. Available from: https://pubmed.ncbi.nlm.nih.gov/25946691/
  15. Pires J, Nadal J, Gomes NL. Internal limiting membrane translocation for refractory macular holes. Br J Ophthalmol [Internet]. 2017 [cited 2023 Jan 10];101(3):377–82. Available from: https://pubmed.ncbi.nlm.nih.gov/27146153/
  16. Rizzo S, Caporossi T, Tartaro R, Finocchio L, Franco F, Barca F, et al. A Human Amniotic Membrane Plug to Promote Retinal Breaks Repair and Recurrent Macular Hole Closure. Retina [Internet]. 2019 Oct 1 [cited 2023 Jan 10];39 Suppl 1:S95–103. Available from: https://pubmed.ncbi.nlm.nih.gov/30312261/
  17. Grewal DS, Mahmoud TH. Autologous Neurosensory Retinal Free Flap for Closure of Refractory Myopic Macular Holes. JAMA Ophthalmol [Internet]. 2016 Feb 1 [cited 2023 Jan 10];134(2):229–30. Available from: https://pubmed.ncbi.nlm.nih.gov/26720054/
  18. Chen SN, Yang CM. Lens Capsular Flap Transplantation in The Management of Refractory Macular Hole From Multiple Etiologies. Retina [Internet]. 2016 [cited 2023 Jan 10];36(1):163–70. Available from: https://pubmed.ncbi.nlm.nih.gov/26200509/
  19. Charles S, Randolph JC, Neekhra A, Salisbury CD, Littlejohn N, Calzada JI. Arcuate retinotomy for the repair of large macular holes. Ophthalmic Surg Lasers Imaging Retina [Internet]. 2013 Jan [cited 2023 Jan 10];44(1):69–72. Available from: https://pubmed.ncbi.nlm.nih.gov/23418735/
  20. Figueroa MS, Govetto A, Arriba-Palomero P de. Short-term results of platelet-rich plasma as adjuvant to 23-G vitrectomy in the treatment of high myopic macular holes. Eur J Ophthalmol [Internet]. 2016 Dec 22 [cited 2023 Jan 10];26(5):491–6. Available from: https://pubmed.ncbi.nlm.nih.gov/26742873/
  21. Gehring S, Hoerauf H, Laqua H, Kirchner H, Klüter H. Preparation of autologous platelets for the ophthalmologic treatment of macular holes. Transfusion (Paris) [Internet]. 1999 [cited 2023 Jan 10];39(2):144–8. Available from: https://pubmed.ncbi.nlm.nih.gov/10037123/
  22. Sánchez-Ávila RM, Robayo-Esper CA, Villota-Deleu E, Fernández-Vega Sanz Á, Fernández-Vega González Á, de la Sen-Corcuera B, et al. Plasma Rich in Growth Factors in Macular Hole Surgery. Clin Pract [Internet]. 2022 Jan 10 [cited 2023 Jan 10];12(1):57–69. Available from: https://pubmed.ncbi.nlm.nih.gov/35076502/
  23. Ito Y, Terasaki H, Takahashi A, Yamakoshi T, Kondo M, Nakamura M. Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes. Ophthalmology [Internet]. 2005 Aug [cited 2023 Jan 10];112(8):1415–20. Available from: https://pubmed.ncbi.nlm.nih.gov/16061095/
  24. Alkabes M, Salinas C, Vitale L, Burés-Jelstrup A, Nucci P, Mateo C. En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci [Internet]. 2011 Oct [cited 2023 Jan 10];52(11):8349–55. Available from: https://pubmed.ncbi.nlm.nih.gov/21862645/
  25. Steel DHW, Dinah C, White K, Avery PJ. The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane. Acta Ophthalmol [Internet]. 2017 Mar 1 [cited 2023 Jan 10];95(2):153–7. Available from: https://pubmed.ncbi.nlm.nih.gov/27572851/
  26. Smiddy WE, Glaser BM, Green WR, Connor TB, Roberts AB, Sporn MB, et al. Transforming growth factor beta. A biologic chorioretinal glue. Arch Ophthalmol [Internet]. 1989 [cited 2023 Jan 10];107(4):577–80. Available from: https://pubmed.ncbi.nlm.nih.gov/2705928/
  27. Vote BJ, Membrey WL, Casswell AG. Autologous platelets for macular hole surgery: the Sussex Eye Hospital experience. Clin Exp Ophthalmol. 2004 Oct;32(5):472–7.
  28. Gaudric A, Massin P, Paques M, Santiago PY, Guez JE, le Gargasson JF, et al. Autologous platelet concentrate for the treatment of full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol [Internet]. 1995 Sep [cited 2023 Jan 11];233(9):549–54. Available from: https://pubmed.ncbi.nlm.nih.gov/8543204/
  29. Gaudric A, Paques M, Massin P, Santiago PY, Dosquet C. Use of autologous platelet concentrate in macular hole surgery: report of 77 cases. Dev Ophthalmol [Internet]. 1997 [cited 2023 Jan 11];29:30–5. Available from: https://pubmed.ncbi.nlm.nih.gov/9413691/
  30. Kapoor KG, Khan AN, Tieu BC, Khurshid GS. Revisiting autologous platelets as an adjuvant in macular hole repair: chronic macular holes without prone positioning. Ophthalmic Surg Lasers Imaging [Internet]. 2012 Jul [cited 2023 Jan 11];43(4):291–5. Available from: https://pubmed.ncbi.nlm.nih.gov/22589336/
  31. Purtskhvanidze K, Frühsorger B, Bartsch S, Hedderich J, Roider J, Treumer F. Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood. Ophthalmologica [Internet]. 2018 Dec 1 [cited 2023 Jan 11];239(1):19–26. Available from: https://pubmed.ncbi.nlm.nih.gov/29050013/
  32. Kube T, Hermel M, Dahlke C, Hutschenreuter G, Schrage N, Kirchhof B. [Macular hole surgery: experience with autologous platelet concentrate and indocyanine green-assisted internal limiting membrane peeling]. Klin Monbl Augenheilkd [Internet]. 2002 Dec 1 [cited 2023 Jan 11];219(12):883–8. Available from: https://pubmed.ncbi.nlm.nih.gov/12548474/
  33. Rangel CM, Blanco NA, Pedraza-Concha A, Gomez MA, Parra MM, Arias JD. Plasma rich in growth factors as treatment for a full-thickness macular hole due to macular telangiectasia type 2. Arch Soc Esp Oftalmol [Internet]. 2022 Apr [cited 2023 Jan 22];97(4):219–23. Available from: https://pubmed.ncbi.nlm.nih.gov/35523468/
  34. Arias JD, Hoyos AT, Alcántara B, Sanchez-Avila RM, Arango FJ, Galvis V. Plasma Rich in Growth Factors For Persistent Macular Hole: A Pilot Study. Retin Cases Brief Rep [Internet]. 2022 Mar 1 [cited 2023 Jan 22];16(2):155–60. Available from: https://pubmed.ncbi.nlm.nih.gov/31895724/
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