Extended follow-up of ultrastructural remodeling and functional recovery after lamellar macular hole surgery using autologous platelet-rich plasma

Abstract

Abstract This prospective interventional case study aimed to describe the anatomical and functional outcomes of pars plana vitrectomy (PPV) with adjunct highly concentrated autologous platelet-rich plasma (PRP) in patients with symptomatic, progressive lamellar macular hole (LMH) over an extended follow-up period. 20 eyes of 20 patients were included with a minimum follow-up of 24 months (mean 40.2 ± 11.8 months) and a morphological diagnosis of LMH. 23-/25-gauge PPV was conducted with peeling of the internal limiting membrane (ILM) and epiretinal proliferation (ERP; if present) with intraoperative application of autologous PRP under air or gas tamponade. Combined phacovitrectomy was performed in phakic eyes. Foveal anatomy was restored in all cases at first follow-up. Best-corrected visual acuity (BCVA) significantly improved from 0.36 ± 0.16 logMAR to 0.19 ± 0.24 logMAR at final follow-up (mean 0.17 logMAR, p  = 0.005). Central retinal thickness (CRT) increased significantly ( p  < 0.001), indicating retinal restoration. Ellipsoid Zone (EZ) defects, initially present in 80% of patients, fully resolved in 62.5% with a significant reduction of defect width ( p  = 0.005). Microperimetry was stable throughout the entire follow-up. Three patients developed recurrent defects possibly attributable to insufficient peeling or postoperative position. No other significant intra- or postoperative complications were recorded. Autologous PRP in LMH surgery is safe and might be an effective adjuvant, potentially offering long-term anatomical stability and functional recovery while reducing the risk of postoperative complications. Those observed effects are exploratory as the cohort size is small and a control group is missing. A main strength of our study is the extended follow-up period which is essential to capture all possible regeneration mechanism.