Anatomical and functional results of plasma rich in growth factors as a treatment for poor-prognosis macular holes.

Abstract

Purpose: The management of poor-prognosis full-thickness macular holes (FTMH), considered as large, myopic, recurrent, or persistent, is challenging, and there is no consensus on the most suitable option. Plasma rich in growth factors (PRGF) is a subtype of platelet-rich plasma with a higher concentration of growth factors, which promotes Müller cell proliferation and, therefore, closure of FTMH. This study aims to analyze the benefits of injectable plasma rich in growth factors (iPRGF) as an adjuvant to PPV in poor-prognosis FTMH.

Materials and methods: A prospective, non-randomized study was conducted in patients with poor-prognosis FTMH. Patients were treated with PPV associated with adjuvant iPRGF. Postoperative best corrected visual acuity (BCVA), FTMH closure, retinal layer restoration, and type of closure were analyzed.

Results: A total of 12 eyes were included in the study. Complete closure of the FTMH was achieved in 92% of the patients, and BCVA improvement in 75%. Reconstitution of the external retinal layers was observed in 41% of the patients, and closure type 1A in 41%. No adverse effects were recorded.

Discussion: The high closure rate and visual improvement suggest that iPRGF is a promising adjuvant in poor-prognosis FTMH, likely through Müller cell stimulation and glial-mediated tissue repair. Compared with more complex techniques such as inverted ILM flaps or autologous retinal transplants, iPRGF offers a more straightforward, safer, and faster approach, particularly in myopic or recurrent cases. The potential synergistic effect of combining iPRGF with ILM flap techniques warrants further investigation.

Conclusion: The use of iPRGF may be an effective technique for achieving anatomical closure, restoring retinal layers, and improving final BCVA.