PMC6634266_01
Retinography and optical coherence tomography (OCT) of recurrent myopic macular hole. (A) Retinography of the right eye showing the macular hole. (B) OCT of recurrent myopic macular hole in the right eye.
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Three months later, the visual symptoms returned (metamorphopsia), the VA had not improved (count fingers), and a MH recurrence was observed (700 microm), associated with subretinal fluid, intraretinal hemorrhages, and pigment dispersion (Figure 1).
Surgery in the recurrent myopic macular hole (PPV + extended Internal Limiting Membran (ILM) peeling + PRGF-membrane). (A) Macular hole staining. (B) Extended ILM peeling. (C) Tap the edges of the macular hole. (D) PRGF-membrane introduction into vitreous cavity. (E) PRGF-membrane position into the macular hole. (F) fluid-air-gas exchange.. Abbreviations: PRGF, plasma rich in growth factors; PPV, pars plana vitrectomy.
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The surgical procedure consisted in enlarging the peeling of the ILM, close to the optic nerve and the vascular arcade and tap the edges of the MH (to increase the probability of closing the MH, technique proposed by the retina surgeon: AFVS). Then, the PRGF membrane was introduced through the trocar and placed inside the MH (the thickness of the membrane was 100 microm), without pressure and without forcing the adhesion (PRGF fibrin membrane have adhesion properties when it comes into contact with the cell surface) trying to avoid the potential damage to the retinal pigment epithelium; subsequently three drops of liquid PRGF were placed in the MH, and a fluid-gas (C3F8) exchange was performed at the end of the surgery (Figure 2).
Post-surgical follow-up. (A) Three months after treatment with PPV + PRGF membrane. (B) Retinography of the right eye: Image of closed macular hole, macular pigmentary changes.. Abbreviations: PPV, pars plana vitrectomy; PRGF, plasma rich in growth
factor.
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We did not have any new recurrences of the MH in a follow-up period of six months, and VA remained stable during this period (Figure 3).