Blood-Assisted Internal Limiting Membrane Peeling for Macular Hole Repair

Purpose: To evaluate the efficacy of autologous heparinized whole blood in assisting internal limiting membrane (ILM) peeling by coating the ILM for macular hole (MH) repair. Design: Prospective, interventional case series. Participants: Twenty-nine patients (32 eyes) who underwent blood-assisted ILM peeling for MH repair. Methods: Patients in whom stage 2-4 idiopathic MHs had developed and who desired surgery were enrolled in this study. After core vitrectomy, autologous heparinized whole blood was applied to cover the macula and to coat the surface of the macular area in the fluid-filled vitreous cavity. The redundant blood was removed and only a very thin film of blood was left on the macular area. The blood-coated ILM was removed by forceps in a circular fashion. To confirm the removed membrane was the ILM, the first 10 specimens were examined by electron microscopy (EM). Main Outcome Measures: The MH closure rate, the interval mean visual acuity (before and after surgery), retinal changes, and the EM results of the ILM specimens. Results: All 32 eyes in 29 patients completed 12 months of follow-up. The ILM were coated by autologous heparinized whole blood, removed without difficulty, and confirmed by EM. The whole blood highlighted the contrast of the coated and noncoated areas during the ILM peeling procedure. The MHs were closed in all surgical eyes with a single surgery (100%). Compared with study entry, the mean logMAR best-corrected visual acuity 12 months after surgery improved significantly (1.02 and 0.53, respectively; P<0.001). At 12 months of follow-up, 31 eyes (96.9%) had stable or improved vision. No toxic fundus changes were observed during follow-up. Conclusions: Autologous heparinized whole blood coated the ILM and facilitated visibility during ILM peeling. Autologous heparinized whole blood is a cost-effective and useful tool for assisting MH surgery. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2009;116:1525-1530 (C) 2009 by the American Academy of Ophthalmology.