Plasma rich in growth factors membrane for macular holes in eyes with pathological myopia without peeling of internal limiting membrane

Plasma rich in growth factors membrane for macular holes in eyes with pathological myopia without peeling of internal limiting membrane | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Plasma rich in growth factors membrane for macular holes in eyes with pathological myopia without peeling of internal limiting membrane Carlos M. Córdoba-Ortega, Juan D. Arias, Jenyffer M. Barahona-Campos, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9131941/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Myopic macular holes (MH) present a significant surgical challenge due to their low closure rates and poor visual prognosis. Conventional approaches frequently require internal limiting membrane (ILM) peeling, which adds surgical complexity and potential risks. Plasma rich in growth factors membrane (PRGFm) has emerged as a biological scaffold that promotes retinal repair and may facilitate MH closure without ILM manipulation. This study aims to evaluate the usefulness of PRGFm in improving closure of myopic macular holes without peeling of the ILM. Methods Observational study of a consecutive case series. Pathological myopia patients with MH. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) data, anatomic closure rates were documented. Results 7 patients who met the inclusion criteria were enrolled. Median follow-up was 6 months. The MH before surgery had a median size of 810 micrometers, most patients had a BCVA of counting fingers (CF) (2.0 logMAR). Complete macular hole closure was achieved in all cases, and median BCVA was 20/100 (0.7 logMAR). No complications related to PRGFm were found. Conclusion PRGFm is a valuable option for the treatment of MH in pathologic myopic eyes. Its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane. Macular hole pathological myopia plasma rich in growth factors membrane retina Figures Figure 1 Figure 2 Figure 3 Background Pathological myopia is a refractive defect characterized by increased axial length > 26.5 mm and/or spherical equivalent > − 6.00 diopters accompanied by structural changes in the posterior segment. These changes include posterior staphyloma, myopic maculopathy, macular hole (MH) and optic neuropathy. MH with retinal detachment is a complication of high myopia, associated with posterior staphyloma, with a documented prevalence of 8.4%. 1 Myopic MH are caused by vitreous traction at the fovea in the anteroposterior and tangential direction. In addition, the posterior staphyloma (PS) is an outpouching of the posterior fundus, increases tractional forces depending on its depths and location relative to the macula. 1,2 Pars plana vitrectomy (PPV) is the surgical technique of choice for the treatment of MH. This intervention is usually accompanied by peeling of the internal limiting membrane, to release vitreoretinal traction forces. 3 PRGFm is an emerging innovative therapy that allows the continuous release of biologically active agents for an adequate tissue regeneration process. The combination of fibrin and growth factors helps generate a structural support that facilitates cell adhesion and tissue organization, achieving satisfactory retinal tissue regeneration. 4 Methods We report a case series in which patients with clinical and imaging characteristics consistent with pathological myopia who underwent PPV + PRGFm for the treatment of MH with or without prior surgical interventions were included. Approved by the Institutional Research Committee of the Fundación Oftalmológica de Santander (FOSCAL) (Bucaramanga, Colombia) and following good clinical practice guidelines and the Declaration of Helsinki, all patients signed a written informed consent after detailed explanations about the procedure, risks and expectations were provided. The PRGFm preparation process was carried out as follows: in 4.5mL tubes with 3.2% sodium citrate, an autologous blood sample of approximately 21mL is obtained, which is then centrifuged at 300 x g for 5 minutes at 18°C. After separating the plasma containing the platelets, they are centrifuged at 700 x g for 17 minutes at 18°C and resuspended to obtain a concentration of 1x109 platelets/mL. CaCl2 (Sigma-Aldrich, St. Louis, MO, USA) is added to trigger platelet activation and incubated at 37°C for 1 hour to obtain PRGFm. Preoperative and postoperative best-corrected visual acuity (BCVA) data were obtained, images taken with Swept Source OCT (SS-OCT) to document the preoperative macular hole (MH) size, classified according to the CLOSE study group 5 , and posterior staphylomas, using the Ohno-Matsui classification 6 . Data were reported qualitatively and using descriptive statistics where appropriate. The seven cases identified with MH related to pathological myopia were managed using PPV in combination with PRGFm alongside a gas tamponade agent (SF6 20%), without performing inner limiting membrane peeling. Since the PRGFm fragment tends to shrink, we used a slightly larger size than the macular hole and filled it to improve adherence and sustained release of growth factors. Subsequent follow-up evaluations were conducted utilizing SS-OCT-A imaging. Results Seven patients (seven eyes) were included. The overall mean age was 57.42 ± 4.43 (52–66) years. 71.43% were right eyes, and 28.57% left eyes. All the patients were women. The median axial length was 33.22 mm (±0.91). Four eyes had type 1 posterior staphyloma, and three had type 2. Only 1 patient had no previous surgeries, 6 patients were pseudophakic. Patient 7 had 4 previous surgeries. Two eyes had previous PLMI (table 1). Prior to surgery, the MH had a median size of 810µm (range 532-2286 µm). Most patients presented with a preoperative BCVA of 2.0 LogMAR (counting fingers (CF)) (table 2). Case 1 involves a 56-year-old woman without any previous surgical history, presenting with an 811 µm MH, with an axial length of 33.21 mm and a type 2 staphyloma in the right eye. The patient exhibited visual enhancement, progressing from CF corresponding to a logarithm of the minimum angle of resolution (logMAR) of 2.0 to 20/150 (logMAR 0.9) by the conclusion of the follow-up period. The surgical intervention did not include any manipulation of the Internal Limiting Membrane (ILM) (Figure 1). Case 2 involves a 66-year-old female patient with a MH measuring 711 µm, with an axial length of 33.30 mm and a type 1 staphyloma in the right eye. This patient had previously undergone PPV along with ILM peeling one year prior. Initially, the BCVA was recorded as CF (logMAR 2.0) at baseline, showing improvement to 20/200 (logMAR 1.0) by the end of the follow-up period. Case 3 pertains to a 56-year-old woman pseudophakic presenting with a 802 µm MH with an axial length of 35,02 mm and a type 2 staphyloma in the left eye. This eye had not received any prior treatment for the condition. PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from CF (logMAR 2.0) to 20/80 (logMAR 0.6) by the end of the follow-up period. Case 4 involves a 53-year-old woman pseudophakic presenting with a 988 µm MH with an axial length of 33,11 mm and a type 2 staphyloma in the right eye. PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from 20/400 (logMAR 1.3) to 20/80 (logMAR 0.6) by the end of the follow-up period. Case 5 pertains to a 57-year-old woman pseudophakic presenting with a 1220 µm MH (Giant) with an axial length of 32,10 mm and a type 1 staphyloma in the right eye. PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from CF (logMAR 2.0) to 20/200 (logMAR 1.0) by the end of the follow-up period. Case 6 involves a 61-year-old female patient with a MH measuring 2286 µm (giant) (figure 2), with an axial length of 33.20 mm and a type 1 staphyloma in the left eye. This patient had previously undergone PPV along with ILM peeling one year prior. Initially, the best corrected visual acuity was recorded as 20/400 (logMAR 1.3) at baseline, showing improvement to 20/200 (logMAR 1.0) by the end of the follow-up period. Case 7 involves a 52-year-old female patient with a MH measuring 532 µm, with an axial length of 32.50 mm and a type 1 staphyloma in the right eye. This patient had undergone four previous surgeries: the first was a retinopexy, the second was phacoemulsification (FACO) with intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) with SF6 gas, the third was a PPV with silicone oil (SO) injection, and the fourth was a PPV with silicone oil removal performed three months prior. Initially, the best corrected visual acuity was recorded as 20/400 (logMAR 1.3) at baseline, showing improvement to 20/150 (logMAR 0.9) by the end of the follow-up period (figure 3). The median duration of follow-up was 6 months (ranging from 6 to 12 months), exhibiting a 100% closure rate in terms of anatomical improvement. The median change in BCVA was 20/100 (0.7 logMAR) (range 20/80-20/200 (0.6- 1.0 logMAR)). There were no recorded complications or adverse reactions associated with the use of PRGFm. (table 2) Discussion In the field of retinal surgery, macular holes (MH) in patients with pathological myopia represent a formidable obstacle. The distinct anatomical features of myopic eyes require innovative strategies for surgical intervention. We examined the effectiveness of treating with a plasma rich in growth factors membrane (PRGFm) in our observational case series, demonstrating promising results without the need for peeling the internal limiting membrane (ILM). The use of PRGFm has been used in various cases of MH, anatomical and functional success has been reported, Sanchez-Avila et al 3 reported a case of a 71-year-old patient with recurrent myopic macular hole, in which restoration of the anatomy and complete closure of the MH was obtained, as well as Arias-Juan et al 7 present 2 case reports of persistent MH where PRGFm was used and complete closure of MH and improvement of best corrected visual acuity were obtained. Our findings are consistent with earlier research indicating that PRGFm can aid in anatomical closure of retinal holes. The 100% closure rate seen in our investigation demonstrates the potential of PRGFm to improve healing processes by releasing growth factors that promote tissue regeneration. In our study the median improvement in BCVA of 20/100 (0.7 LogMAR) is significant especially considering that most patients initially had hand motion vision. This reinforces the case for including PRGFm in patients with pathological myopia and MH. While prior studies have found varying success rates after standard vitrectomy and ILM peeling, our findings show that PRGFm can yield equivalent, if not superior, results without the dangers associated with ILM manipulation. Avoiding ILM peeling may lessen the risk of extra retinal trauma, which can be especially useful in eyes that have already undergone previous surgical treatments or in those that are more prone to problems. While our sample size is limited, the lack of problems associated with the use of PRGFm highlights its safety as a surgical adjuvant. Conclusions The use of PRGFm is a valuable option in the surgical management of MH in pathologic myopic eyes. Our findings support its greater use in clinical practice, its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Research Committee of the Fundación Oftalmológica de Santander (FOSCAL) (Bucaramanga, Colombia) and following good clinical practice guidelines, all patients signed a written informed consent after detailed explanations about the procedure, risks and expectations were provided. Consent for publication Written informed consent for publication of anonymized clinical data and images was obtained from all patients included in this study. All images included in this manuscript were obtained by the authors and are original. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding None. Authors’ contributions JA and CC contributed to the surgical procedures. JB, MG, and ML contributed to the study design and manuscript drafting. JB, ML and CC participated in data collection and analysis. CC, ML and JA critically revised the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. References De Giacinto C, Pastore MR, Cirigliano G, Tognetto D. Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol. 2019 Mar 11;2019:3230695. doi: 10.1155/2019/3230695. Ohno-Matsui K, Wu PC, Yamashiro K, Vutipongsatorn K, Fang Y, Cheung CMG, et al. IMI Pathologic Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):5. doi: 10.1167/iovs.62.5.5. Sánchez-Ávila RM, Fernández-Vega González Á, Fernández-Vega Sanz Á, Merayo-Lloves J. Treatment of recurrent myopic macular hole using membrane of plasma rich in growth factors. Int Med Case Rep J. 2019 Jul 12;12:229-233. doi: 10.2147/IMCRJ.S170329. Rangel CM, Blanco NA, Pedraza-Concha A, Gomez MA, Parra MM, Arias JD. Plasma rich in growth factors as treatment for a full-thickness macular hole due to macular telangiectasia type 2. Arch Soc Esp Oftalmol (Engl Ed). 2022 Apr;97(4):219-223. doi: 10.1016/j.oftale.2020.11.017. Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, et al. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous. 2023 Jan 30;9(1):4. doi: 10.1186/s40942-022-00439-4. Ohno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging. Ophthalmology. 2014 Sep;121(9):1798-809. doi: 10.1016/j.ophtha.2014.03.035. Arias JD, Hoyos AT, Alcántara B, Sanchez-Avila RM, Arango FJ, Galvis V. Plasma rich in growth factors for persistent macular hole: a pilot study. Retin Cases Brief Rep. 2022 Mar 1;16(2):155-160. doi: 10.1097/ICB.0000000000000957. Tables Table1. Baseline characteristics of patients with macular holes. Num. Patient/Age (Years)/Gender Laterality (Eye) Axial length Type of staphyloma. Number of Previous Surgeries Detail of Previous Surgeries PLMI previous 1/56/F R 33,21 type 2 0 N/A no 2/66/F R 33,30 type 1 1 1st: PHACO + IOL PPV + P-ILM yes 3/56/F L 35,02 type 2 1 1st: PHACO IOL no 4/53/F R 33,11 type 2 1 1st: PHACO IOL no 5/57/F R 32,10 type 1 1 1st: PHACO IOL no 6/61/F L 33,20 type 1 1 1st: FACO+ IOL+ PPV + P-ILM yes 7/52/F R 32,50 type 1 4 1st: RPx; 2nd:PHACO IOL+ PPV+ SF6. 3rd: PPV+SO 4th: PPV+ SO removal no F: Female, R: Right, L: Left,PPV: Pars Plana Vitrectomy, PHACO: phacoemulsification, IOL: intraocular lens P-ILM: Peeling of Internal Limiting Membrane, N/A: Not applicable. RPx: Retinopexy. SO: Silicone Oil. Type of Staphyloma: type I : wide, macular staphyloma, type II: Narrow, macular staphyloma, type III peripapillary staphyloma, type IV: nasal staphyloma, type V inferior staphyloma. Table 2 . Pre-surgical data and post-surgery results. Case BCVA .Snellen Pre-Surgical; Decimal (LogMAR) Diameter of MH (µm) Classification BCVA Final; Decimal (LogMAR) one month BCVA Final; Decimal (LogMAR) 3 month BCVA Final; Decimal (LogMAR) 6 month Follow-Up Time (Month) Final Closure of MH 1 CF (2.0) 811 XXL 20/400 (1.3) 20/200 (1,0) 20/150 (0.9) 6 Yes 2 CF (2.0) 711 XL 20/400 (1.3) 20/400 (1.3) 20/200 (1.0) 6 Yes 3 CF (2.0) 802 XXL 20/150 (0.9) 20/150 (0.9) 20/80 (0.6) 12 Yes 4 20/400 (1.3) 988 XXL 20/80 (0.6) 20/80 (0.6) 20/80 (0.6) 12 Yes 5 CF (2.0) 1220 GIANT 20/400 (1.3) 20/400 (1.3) 20/200 (1,0) 6 Yes 6 20/400 (1.3) 2286 GIANT 20/400 (1.3) 20/400 (1.3) 20/200 (1,0) 6 Yes 7 20/400 (1.3) 532 LARGE 20/150 (0.9) 20/150 (0.9) 20/150 (0.9) 6 Yes BCVA: Best Corrected Visual Acuity, CF: counting fingers, MH: Macular Hole, MH Classification: large: 400–535 µm, X-large: 536–799 µm,XX-Large: 800–999 µm, and Giant:> 1,000 µm Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 28 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviews received at journal 24 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 24 Mar, 2026 Submission checks completed at journal 24 Mar, 2026 First submitted to journal 23 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9131941","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611345706,"identity":"84d7598e-72c6-4de8-9e33-201713a59b1f","order_by":0,"name":"Carlos M. Córdoba-Ortega","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYNACNoYEBgbmAwwMBhYkaWEDYgMJkrTwGABZRGjhn3b44eOKMps8/vaerxt+FEgw8Ld3J+DVInE7zdjwzLm0YokzZ7fd7AE6DMjYgFeLgXQOm2Rj2+HEhhu5227wALUYSOQSqWX+jZxnN/+QpGXDjRy220TZAvZLA9AvhmeOmd2WMZDgIegX/tnJDx82AENM7njzs5tv/tjI8bf34teCAXhIUz4KRsEoGAWjACsAAMLFRrlECjWAAAAAAElFTkSuQmCC","orcid":"","institution":"International Clinic","correspondingAuthor":true,"prefix":"","firstName":"Carlos","middleName":"M.","lastName":"Córdoba-Ortega","suffix":""},{"id":611345707,"identity":"abdea9c5-edea-4986-80e0-05cd44f0b9e2","order_by":1,"name":"Juan D. Arias","email":"","orcid":"","institution":"International Clinic","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"D.","lastName":"Arias","suffix":""},{"id":611345708,"identity":"03cff607-9a46-4f07-96ff-a03f72ed1f45","order_by":2,"name":"Jenyffer M. Barahona-Campos","email":"","orcid":"","institution":"International Clinic","correspondingAuthor":false,"prefix":"","firstName":"Jenyffer","middleName":"M.","lastName":"Barahona-Campos","suffix":""},{"id":611345709,"identity":"0daa140f-71dd-432a-a80e-54f779275949","order_by":3,"name":"Maira A. Gomez-Velasco","email":"","orcid":"","institution":"International Clinic","correspondingAuthor":false,"prefix":"","firstName":"Maira","middleName":"A.","lastName":"Gomez-Velasco","suffix":""},{"id":611345710,"identity":"be737b64-7914-4dd2-8a76-e710d75ae774","order_by":4,"name":"María J. Lizarazo","email":"","orcid":"","institution":"International Clinic","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"J.","lastName":"Lizarazo","suffix":""}],"badges":[],"createdAt":"2026-03-16 01:53:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9131941/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9131941/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105519106,"identity":"940170c6-bfbd-4db0-b04c-9cdec77859b0","added_by":"auto","created_at":"2026-03-27 01:47:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3435651,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient number 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient number 1 with MMH (myopic macular hole) in the right eye, the best corrected visual acuity before surgery was counting finger \u003cstrong\u003eA.\u003c/strong\u003e Color fundus montage of MMH before surgery with PRGFm \u003cstrong\u003eA1.\u003c/strong\u003e Pre-surgical OCT of XLL MMH with type 2 staphyloma \u003cstrong\u003eB.\u003c/strong\u003e Color fundus montage at one week follow-up B1. OCT macular image one week after surgery, adhered PRGFm, restoration of the (ELM) External Limiting Membrane. \u003cstrong\u003eC.\u003c/strong\u003e Color fundus montage at one month follow-up \u003cstrong\u003eC1.\u003c/strong\u003eOCT macular image one month after surgery, the formation of the ELM is observed, the macular hole completely closed.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9131941/v1/1f6d99cb0790088fa2a8bae6.png"},{"id":105519104,"identity":"33ed86c3-32b0-4a99-a89f-17c6ae1243b2","added_by":"auto","created_at":"2026-03-27 01:47:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3918156,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient number 6.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient number 6 with MMH in the left eye, the best corrected visual acuity before surgery was 20/400 A. Color fundus montage of MMH before surgery with PRGFm A\u003cstrong\u003e1.\u003c/strong\u003e Pre-surgical OCT of giant MMH with type 1 staphyloma\u003cstrong\u003e B. \u003c/strong\u003eColor fundus montage at one week follow-up \u003cstrong\u003eB1. \u003c/strong\u003eOCT macular image one week after surgery, adhered PRGFm, subretinal fluid is observed\u003cstrong\u003e C.\u003c/strong\u003e Color fundus montage at one month follow-up \u003cstrong\u003eC1.\u003c/strong\u003e OCT macular image one month after surgery showing the formation of the ELM, reabsorption of subretinal fluid and closed MH.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9131941/v1/58575e0e3fc1987f5f5e8e24.png"},{"id":105566817,"identity":"2d4877ce-4ba5-4e31-a176-1ab71549be47","added_by":"auto","created_at":"2026-03-27 12:57:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":3480439,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient number 7.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient number 7 with MMH in the right eye, the best corrected visual acuity before surgery was 20/400 A.\u003cstrong\u003e \u003c/strong\u003eColor fundus montage of MMH before surgery with PRGFm \u003cstrong\u003eA1. \u003c/strong\u003ePre-surgical OCT of large MMH with type 1 staphyloma \u003cstrong\u003eB. \u003c/strong\u003eColor fundus montage at one week follow-up\u003cstrong\u003e B1.\u003c/strong\u003e OCT macular image one week after surgery, showing adhered PRGFm \u003cstrong\u003eC. \u003c/strong\u003eColor fundus montage at one month follow-up \u003cstrong\u003eC1. \u003c/strong\u003eOCT macular image one month after surgery showing the formation of the ELM and the ellipsoid layer, MH the macular hole completely closed.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9131941/v1/480c8fb06490d83fb5960922.png"},{"id":105570349,"identity":"31992249-a53b-4478-a16f-da399067f1dd","added_by":"auto","created_at":"2026-03-27 13:16:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":10756897,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9131941/v1/3c6f2884-fb64-47f7-aa9a-7771e1c615e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Plasma rich in growth factors membrane for macular holes in eyes with pathological myopia without peeling of internal limiting membrane","fulltext":[{"header":"Background","content":"\u003cp\u003ePathological myopia is a refractive defect characterized by increased axial length\u0026thinsp;\u0026gt;\u0026thinsp;26.5 mm and/or spherical equivalent\u0026thinsp;\u0026gt;\u0026thinsp;\u0026minus;\u0026thinsp;6.00 diopters accompanied by structural changes in the posterior segment. These changes include posterior staphyloma, myopic maculopathy, macular hole (MH) and optic neuropathy. MH with retinal detachment is a complication of high myopia, associated with posterior staphyloma, with a documented prevalence of 8.4%.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMyopic MH are caused by vitreous traction at the fovea in the anteroposterior and tangential direction. In addition, the posterior staphyloma (PS) is an outpouching of the posterior fundus, increases tractional forces depending on its depths and location relative to the macula. \u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePars plana vitrectomy (PPV) is the surgical technique of choice for the treatment of MH. This intervention is usually accompanied by peeling of the internal limiting membrane, to release vitreoretinal traction forces. \u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePRGFm is an emerging innovative therapy that allows the continuous release of biologically active agents for an adequate tissue regeneration process. The combination of fibrin and growth factors helps generate a structural support that facilitates cell adhesion and tissue organization, achieving satisfactory retinal tissue regeneration. \u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe report a case series in which patients with clinical and imaging characteristics consistent with pathological myopia who underwent PPV\u0026thinsp;+\u0026thinsp;PRGFm for the treatment of MH with or without prior surgical interventions were included. Approved by the Institutional Research Committee of the Fundaci\u0026oacute;n Oftalmol\u0026oacute;gica de Santander (FOSCAL) (Bucaramanga, Colombia) and following good clinical practice guidelines and the Declaration of Helsinki, all patients signed a written informed consent after detailed explanations about the procedure, risks and expectations were provided. The PRGFm preparation process was carried out as follows: in 4.5mL tubes with 3.2% sodium citrate, an autologous blood sample of approximately 21mL is obtained, which is then centrifuged at 300 x g for 5 minutes at 18\u0026deg;C. After separating the plasma containing the platelets, they are centrifuged at 700 x g for 17 minutes at 18\u0026deg;C and resuspended to obtain a concentration of 1x109 platelets/mL. CaCl2 (Sigma-Aldrich, St. Louis, MO, USA) is added to trigger platelet activation and incubated at 37\u0026deg;C for 1 hour to obtain PRGFm.\u003c/p\u003e \u003cp\u003ePreoperative and postoperative best-corrected visual acuity (BCVA) data were obtained, images taken with Swept Source OCT (SS-OCT) to document the preoperative macular hole (MH) size, classified according to the CLOSE study group\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and posterior staphylomas, using the Ohno-Matsui classification\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Data were reported qualitatively and using descriptive statistics where appropriate.\u003c/p\u003e \u003cp\u003eThe seven cases identified with MH related to pathological myopia were managed using PPV in combination with PRGFm alongside a gas tamponade agent (SF6 20%), without performing inner limiting membrane peeling. Since the PRGFm fragment tends to shrink, we used a slightly larger size than the macular hole and filled it to improve adherence and sustained release of growth factors. Subsequent follow-up evaluations were conducted utilizing SS-OCT-A imaging.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSeven patients (seven eyes) were included. The overall mean age was 57.42 \u0026plusmn; 4.43 (52\u0026ndash;66) years. 71.43% were right eyes, and 28.57% left eyes. All the patients were women. \u0026nbsp;The median axial length was 33.22 mm (\u0026plusmn;0.91). Four eyes had type 1 posterior staphyloma, and three had type 2. Only 1 patient had no previous surgeries, 6 patients were pseudophakic. Patient 7 had 4 previous surgeries. Two eyes had previous PLMI (table 1). Prior to surgery, the MH had a median size of 810\u0026micro;m (range 532-2286 \u0026micro;m). Most patients presented with a preoperative BCVA of 2.0 LogMAR (counting fingers (CF)) (table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 1\u003c/strong\u003e involves a 56-year-old woman without any previous surgical history, presenting with an 811 \u0026micro;m MH, with an axial length of 33.21 mm and a type 2 staphyloma in the right eye. The patient exhibited visual enhancement, progressing from CF corresponding to a logarithm of the minimum angle of resolution (logMAR) of 2.0 to 20/150 (logMAR 0.9) by the conclusion of the follow-up period. The surgical intervention did not include any manipulation of the Internal Limiting Membrane (ILM) (Figure 1). \u003cstrong\u003eCase 2\u003c/strong\u003e involves a 66-year-old female patient with a MH measuring 711 \u0026micro;m, with an axial length of 33.30 mm and a type 1 staphyloma in the right eye. This patient had previously undergone PPV along with ILM peeling one year prior. Initially, the BCVA was recorded as CF (logMAR 2.0) at baseline, showing improvement to 20/200 (logMAR 1.0) by the end of the follow-up period. \u0026nbsp; \u0026nbsp;\u003cstrong\u003eCase 3\u0026nbsp;\u003c/strong\u003epertains to a 56-year-old woman pseudophakic presenting with a 802 \u0026micro;m MH with an axial length of 35,02 mm and a type 2 staphyloma in the left eye. This eye had not received any prior treatment for the condition. \u0026nbsp;PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from CF (logMAR 2.0) to 20/80 (logMAR 0.6) by the end of the follow-up period. \u0026nbsp; \u0026nbsp;\u003cstrong\u003eCase 4\u0026nbsp;\u003c/strong\u003einvolves a 53-year-old woman pseudophakic presenting with a 988 \u0026micro;m MH with an axial length of 33,11 mm and a type 2 staphyloma in the right eye. \u0026nbsp;PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from 20/400 (logMAR 1.3) to 20/80 (logMAR 0.6) by the end of the follow-up period. \u0026nbsp;\u003cstrong\u003eCase 5\u003c/strong\u003e pertains to a 57-year-old woman pseudophakic presenting with a 1220 \u0026micro;m MH (Giant) with an axial length of 32,10 mm and a type 1 staphyloma in the right eye. \u0026nbsp;PRGFm and tamponade with 20% SF6 gas were employed, resulting in an improvement of visual acuity from CF (logMAR 2.0) to 20/200 (logMAR 1.0) by the end of the follow-up period. \u003cstrong\u003eCase 6\u003c/strong\u003e involves a 61-year-old female patient with a MH measuring 2286 \u0026micro;m (giant) (figure 2), with an axial length of 33.20 mm and a type 1 staphyloma in the left eye. This patient had previously undergone PPV along with ILM peeling one year prior. Initially, the best corrected visual acuity was recorded as 20/400 (logMAR 1.3) at baseline, showing improvement to 20/200 (logMAR 1.0) by the end of the follow-up period. \u0026nbsp; \u003cstrong\u003eCase 7\u003c/strong\u003e involves a 52-year-old female patient with a MH measuring 532 \u0026micro;m, with an axial length of 32.50 mm and a type 1 staphyloma in the right eye. This patient had undergone four previous surgeries: the first was a retinopexy, the second was phacoemulsification (FACO) with intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) with SF6 gas, the third was a PPV with silicone oil (SO) injection, and the fourth was a PPV with silicone oil removal performed three months prior. Initially, the best corrected visual acuity was recorded as 20/400 (logMAR 1.3) at baseline, showing improvement to 20/150 (logMAR 0.9) by the end of the follow-up period (figure 3). \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median duration of follow-up was 6 months (ranging from 6 to 12 months), exhibiting a 100% closure rate in terms of anatomical improvement. The median change in BCVA was 20/100 (0.7 logMAR) (range 20/80-20/200 (0.6- 1.0 logMAR)). There were no recorded complications or adverse reactions associated with the use of PRGFm. (table 2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the field of retinal surgery, macular holes (MH) in patients with pathological myopia represent a formidable obstacle. The distinct anatomical features of myopic eyes require innovative strategies for surgical intervention. We examined the effectiveness of treating with a plasma rich in growth factors membrane (PRGFm) in our observational case series, demonstrating promising results without the need for peeling the internal limiting membrane (ILM).\u003c/p\u003e \u003cp\u003eThe use of PRGFm has been used in various cases of MH, anatomical and functional success has been reported, Sanchez-Avila et al \u003csup\u003e3\u003c/sup\u003e reported a case of a 71-year-old patient with recurrent myopic macular hole, in which restoration of the anatomy and complete closure of the MH was obtained, as well as Arias-Juan et al \u003csup\u003e7\u003c/sup\u003e present 2 case reports of persistent MH where PRGFm was used and complete closure of MH and improvement of best corrected visual acuity were obtained. Our findings are consistent with earlier research indicating that PRGFm can aid in anatomical closure of retinal holes. The 100% closure rate seen in our investigation demonstrates the potential of PRGFm to improve healing processes by releasing growth factors that promote tissue regeneration.\u003c/p\u003e \u003cp\u003eIn our study the median improvement in BCVA of 20/100 (0.7 LogMAR) is significant especially considering that most patients initially had hand motion vision. This reinforces the case for including PRGFm in patients with pathological myopia and MH.\u003c/p\u003e \u003cp\u003eWhile prior studies have found varying success rates after standard vitrectomy and ILM peeling, our findings show that PRGFm can yield equivalent, if not superior, results without the dangers associated with ILM manipulation. Avoiding ILM peeling may lessen the risk of extra retinal trauma, which can be especially useful in eyes that have already undergone previous surgical treatments or in those that are more prone to problems.\u003c/p\u003e \u003cp\u003eWhile our sample size is limited, the lack of problems associated with the use of PRGFm highlights its safety as a surgical adjuvant.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe use of PRGFm is a valuable option in the surgical management of MH in pathologic myopic eyes. Our findings support its greater use in clinical practice, its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and\u0026nbsp;approved by the Institutional Research Committee of the Fundaci\u0026oacute;n Oftalmol\u0026oacute;gica de Santander (FOSCAL) (Bucaramanga, Colombia) and following good clinical practice guidelines, all patients signed a written informed consent after detailed explanations about the procedure, risks and expectations were provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eWritten informed consent for publication of anonymized clinical data and images was obtained from all patients included in this study. All images included in this manuscript were obtained by the authors and are original.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003eJA and CC contributed to the surgical procedures. JB, MG, and ML contributed to the study design and manuscript drafting. JB, ML and CC participated in data collection and analysis. CC, ML and JA critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDe Giacinto C, Pastore MR, Cirigliano G, Tognetto D. Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol. 2019 Mar 11;2019:3230695. doi: 10.1155/2019/3230695.\u003c/li\u003e\n \u003cli\u003eOhno-Matsui K, Wu PC, Yamashiro K, Vutipongsatorn K, Fang Y, Cheung CMG, et al. IMI Pathologic Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):5. doi: 10.1167/iovs.62.5.5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eS\u0026aacute;nchez-\u0026Aacute;vila RM, Fern\u0026aacute;ndez-Vega Gonz\u0026aacute;lez \u0026Aacute;, Fern\u0026aacute;ndez-Vega Sanz \u0026Aacute;, Merayo-Lloves J. Treatment of recurrent myopic macular hole using membrane of plasma rich in growth factors. Int Med Case Rep J. 2019 Jul 12;12:229-233. doi: 10.2147/IMCRJ.S170329.\u003c/li\u003e\n \u003cli\u003eRangel CM, Blanco NA, Pedraza-Concha A, Gomez MA, Parra MM, Arias JD. Plasma rich in growth factors as treatment for a full-thickness macular hole due to macular telangiectasia type 2. Arch Soc Esp Oftalmol (Engl Ed). 2022 Apr;97(4):219-223. doi: 10.1016/j.oftale.2020.11.017.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, et al. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous. 2023 Jan 30;9(1):4. doi: 10.1186/s40942-022-00439-4.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOhno-Matsui K. Proposed classification of posterior staphylomas based on analyses of eye shape by three-dimensional magnetic resonance imaging and wide-field fundus imaging. Ophthalmology. 2014 Sep;121(9):1798-809. doi: 10.1016/j.ophtha.2014.03.035.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eArias JD, Hoyos AT, Alc\u0026aacute;ntara B, Sanchez-Avila RM, Arango FJ, Galvis V. Plasma rich in growth factors for persistent macular hole: a pilot study. Retin Cases Brief Rep. 2022 Mar 1;16(2):155-160. doi: 10.1097/ICB.0000000000000957.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable1.\u003c/strong\u003e Baseline characteristics of patients with macular holes.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNum. Patient/Age (Years)/Gender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaterality (Eye)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAxial length\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of staphyloma.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Previous Surgeries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDetail of Previous Surgeries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePLMI previous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e1/56/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e33,21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e2/66/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e33,30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: PHACO + IOL PPV + P-ILM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e3/56/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e35,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: PHACO IOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e4/53/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e33,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: PHACO IOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e5/57/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e32,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: PHACO IOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e6/61/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e33,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: FACO+ IOL+ PPV + P-ILM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.4069%;\"\u003e\n \u003cp\u003e7/52/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e32,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14.9842%;\"\u003e\n \u003cp\u003etype 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.9874%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 26.8139%;\"\u003e\n \u003cp\u003e1st: RPx; 2nd:PHACO IOL+ PPV+ SF6. 3rd: PPV+SO 4th: PPV+ SO removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4101%;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eF: Female, R: Right, L: Left,PPV: Pars Plana Vitrectomy, PHACO: phacoemulsification, IOL: intraocular lens \u0026nbsp;P-ILM: Peeling of Internal Limiting Membrane, N/A: Not applicable. RPx: Retinopexy. SO: Silicone Oil. Type of Staphyloma: type I : wide, macular staphyloma, type II: Narrow, macular staphyloma, type III peripapillary staphyloma, type IV: nasal staphyloma, type V inferior staphyloma. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Pre-surgical data and post-surgery results.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBCVA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.Snellen Pre-Surgical; Decimal (LogMAR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiameter of MH (\u0026micro;m)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClassification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBCVA Final; Decimal (LogMAR) one month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBCVA Final; Decimal (LogMAR) \u0026nbsp;3 month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBCVA Final; Decimal (LogMAR) \u0026nbsp;6 month\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-Up Time (Month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal Closure of MH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003eCF (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eXXL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/200 (1,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003eCF (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eXL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/200 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003eCF (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eXXL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/80 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eXXL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/80 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/80 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/80 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003eCF (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e1220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eGIANT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/200 (1,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e2286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eGIANT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/200 (1,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6.17886%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.8699%;\"\u003e\n \u003cp\u003e20/400 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.5935%;\"\u003e\n \u003cp\u003e532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13.8211%;\"\u003e\n \u003cp\u003eLARGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12.3577%;\"\u003e\n \u003cp\u003e20/150 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.7317%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBCVA: Best Corrected Visual Acuity, CF: counting fingers, MH: Macular Hole, MH Classification: large: 400\u0026ndash;535 \u0026micro;m, X-large: 536\u0026ndash;799 \u0026micro;m,XX-Large: 800\u0026ndash;999 \u0026micro;m, and\u0026nbsp;Giant:\u0026gt; 1,000 \u0026micro;m\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Macular hole, pathological myopia, plasma rich in growth factors membrane, retina","lastPublishedDoi":"10.21203/rs.3.rs-9131941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9131941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMyopic macular holes (MH) present a significant surgical challenge due to their low closure rates and poor visual prognosis. Conventional approaches frequently require internal limiting membrane (ILM) peeling, which adds surgical complexity and potential risks. Plasma rich in growth factors membrane (PRGFm) has emerged as a biological scaffold that promotes retinal repair and may facilitate MH closure without ILM manipulation. This study aims to evaluate the usefulness of PRGFm in improving closure of myopic macular holes without peeling of the ILM.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eObservational study of a consecutive case series. Pathological myopia patients with MH. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) data, anatomic closure rates were documented.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e7 patients who met the inclusion criteria were enrolled. Median follow-up was 6 months. The MH before surgery had a median size of 810 micrometers, most patients had a BCVA of counting fingers (CF) (2.0 logMAR). Complete macular hole closure was achieved in all cases, and median BCVA was 20/100 (0.7 logMAR). No complications related to PRGFm were found.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePRGFm is a valuable option for the treatment of MH in pathologic myopic eyes. Its application promotes tissue regeneration and facilitates anatomical closure. The technique is reproducible and does not require manipulation of the internal limiting membrane.\u003c/p\u003e","manuscriptTitle":"Plasma rich in growth factors membrane for macular holes in eyes with pathological myopia without peeling of internal limiting membrane","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 01:47:10","doi":"10.21203/rs.3.rs-9131941/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"78305322413059459424537307343058069740","date":"2026-04-28T12:27:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326166795114931579551857561822671944090","date":"2026-04-13T10:13:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69992878085811274803802121697663984903","date":"2026-03-26T18:16:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-24T11:41:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215930573459940299593796040786855758925","date":"2026-03-24T11:37:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-24T09:39:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T05:19:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Retina and Vitreous","date":"2026-03-23T20:51:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-retina-and-vitreous","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"IJRV","sideBox":"Learn more about [International Journal of Retina and Vitreous](https://jneurodevdisorders.biomedcentral.com/)","snPcode":"40942","submissionUrl":"https://submission.nature.com/new-submission/40942/3","title":"International Journal of Retina and Vitreous","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"533277a3-8781-43f0-b92f-e91d79c54337","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T01:47:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 01:47:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9131941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9131941","identity":"rs-9131941","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}