The no-retina-touch technique: vitrectomy and platelet-rich plasma in the treatment of lamellar macular hole. New insights into pathogenesis

Purpose: To explore the use of autologous platelet-rich plasma (PRP) as a potential therapeutic adjuvant strategy for treating degenerative lamellar macular holes (LMHs). Design: A prospective interventional case series. Methods: Seven consecutive patients (8 eyes) with a diagnosis of LMH underwent a pars-plana vitrectomy with PRP injection under air tamponade. Anatomical results based on spectral domain optical coherence tomography (SD-OCT) and functional results, in terms of best corrected visual acuity (BCVA) and reading performance, were analyzed. Results: At 12 months postoperatively, 7 out of 8 eyes (88%) presented a complete closure of the LMH. The ellipsoid zone (EZ) was restored in 3 eyes (37.5%). The mean (±SD) postoperative BCVA was 0.39 (±0.56) LogMAR, resulting in a statistically significant visual acuity improvement (p= 0.007). The mean (±SD) maximum reading speed (MaxRS) improved to 133.48 (±41.47) wpm, with a significant increase compared to the baseline (p= 0.029). The mean (±SD) reading acuity score (RA score) resulted in 0.44 (±0.04) LogRAD, with an improvement in reading acuity that did not reach statistical significance (p= 0.129). Conclusions: The utilization of the PRP technique with a no-retina-touch approach safeguards the delicate retinal tissues, minimizing the possibility of iatrogenic trauma or post-operative complications, while maintaining a high rate of efficacy in enabling the improvement of the foveal defect in lamellar macular holes.