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Alay S. Banker, MD; William R. Freeman, MD; Stanley P. Azen, PhD; Mei-Ying Lai, MS; and the Vitrectomy for Macular Hole Study Group

Arch Ophthalmol. 1999;117:1499-1502.

Objective  To evaluate and compare the risks and benefits of autologous serum as an adjuvant therapy in macular hole surgery for stage 3 or 4 macular holes.

Methods  Comparison of 2 consecutive (nonrandomized) cohorts using standardized methods for the determination of hole size and for surgical procedures, and using the same study surgeons. The serum cohort consisted of 106 eyes using autologous serum as an adjuvant, and the no serum cohort consisted of 58 eyes without adjuvants. The primary end point was the closure of the macular hole as determined by the 6-month fundus photographs. Secondary end points included the number and types of postoperative complications. Comparison in outcomes between the 2 cohorts used ² and logistic regression procedures, adjusting for preoperative differences between the study cohorts.

Results  At 6 months, the (unadjusted) rate of hole closure was significantly greater for the eyes treated with serum than for the eyes not treated with serum (90 [85%] of 106 vs 40 [69%] of 58, P=.04). However, after adjusting for preoperative differences in hole diameter and the prevalence of epiretinal membranes, no overall difference in hole closure rates due to serum was found (P=.44). In contrast, benefit due to serum for large holes (diameter >573 µm) was seen (12 [75%] of 16 vs 13 [57%] of 23, P=.04). No differences in complication rates were found between the cohorts.

Conclusions  Any beneficial effect of serum used as an adjuvant to macular hole surgery is small, and, if present, the beneficial effect may be limited to larger holes. A randomized, prospective, controlled study in larger macular holes is needed.

From the Department of Ophthalmology, Shiley Eye Center, University of California, San Diego (Drs Banker and Freeman); and the Statistical Consultation and Research Center, Department of Preventive Medicine, University of Southern California, Los Angeles (Dr Azen and Ms Lai).

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