The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular holes

Ophthalmology. 1993 Jun;100(6):868-71; discussion 871-2. doi: 10.1016/s0161-6420(93)31561-7.


Purpose: Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-beta 2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results.

Methods: A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11-81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-beta 2 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole.

Results: Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling.

Conclusion: The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-beta 2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Membrane
  • Child
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Ophthalmic Solutions
  • Retina / drug effects
  • Retinal Perforations / drug therapy
  • Retinal Perforations / surgery
  • Retinal Perforations / therapy*
  • Transforming Growth Factor beta / therapeutic use*
  • Visual Acuity
  • Vitrectomy / methods*
  • Wound Healing / drug effects


  • Ophthalmic Solutions
  • Transforming Growth Factor beta