Comparative Analysis of Adjuvant Autologous Platelet-rich Concentrate Application with Inverted Internal Limiting Membrane Flap Techniques for Macular Hole Patients

Purpose: To evaluate the post-surgical anatomical and functional effects of using autologous platelet-rich concentrate (APC) in patients with macular holes who underwent internal limiting membrane (ILM) flap surgery.Methods: We retrospectively analyzed patients who underwent ILM flap surgery for macular holes at Severance Hospital between January 2018 and December 2022.The evaluation was categorized by APC use, and the clinical course was evaluated for 12 months based on best-corrected visual acuity, surgical success rate, and optical coherence tomography-based anatomical parameters of the macula.Results: Among 111 patients, we used a propensity score analysis based on initial visual acuity, age, axial length, and the longest and shortest diameters of the macular hole to select 25 patients into each of two groups: those treated with and without APC.Visual acuity at 12 months postoperatively did not differ significantly by APC use (absence vs. presence, 0.21 ± 0.22 vs. 0.44 ± 0.46, p = 0.086).There were no significant differences in the anatomical success rate of the surgery, the distance between the macula and the optic nerve head, the height difference between the nasal and temporal sides of the macula, the presence or absence of defects at the outer and inner segment junctions of cone cells, or the presence or absence of external limiting membrane disruption.No serious adverse reactions were observed in either group.Conclusions: Although further research on long-term effects is needed, the use of APC in ILM flap surgery showed no clear additional benefit in our cohort.