title: Plasmin enzyme-assisted vitrectomy in traumatic pediatric macular holes.
abstract: OBJECTIVE
  This study aimed to evaluate the benefit of plasmin enzyme-assisted macular hole surgery on a consecutive series of pediatric patients with traumatic macular holes.
  
  
  METHODS
  Prospective noncomparative case series operated on at William Beaumont Hospital between July 13, 1996, and November 16, 1996, and observed for at least 6 months.
  
  
  METHODS
  During this interval, the authors operated on four eyes from four consecutive patients who were 14 years of age or younger with traumatic macular holes.
  
  
  METHODS
  The patients underwent plasmin enzyme-assisted pars plana vitrectomy with membrane peeling, fluid-gas exchange, and postoperative positioning. The enzyme used was 0.4 international unit (IU) of autologous plasmin enzyme.
  
  
  METHODS
  Snellen lines of improvement in visual acuity and rate of final visual acuity of 20/40 or greater, and incidence of complications and reoperations were measured.
  
  
  RESULTS
  All four macular holes were closed successfully. Follow-up was from 6 to 12 months. There were no reoperations. Visual acuity improved from four to eight lines in all eyes. Three eyes (75%) achieved a postoperative visual acuity of 20/40 or better. Three eyes (75%) had transient, posterior, subcapsular cataracts develop: two of the eyes after surgery and one as a result of the initial injury.
  
  
  CONCLUSIONS
  The treatment of pediatric traumatic macular holes with plasmin enzyme-assisted vitrectomy, membrane peeling, and gas-fluid exchange resulted in closure of the macular holes with significant visual improvement.
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Margherio
authors.forename: R R
authors.initials: RR
authors.lastname: Margherio
authors.forename: M
authors.initials: M
authors.lastname: Hartzer
authors.forename: M T
authors.initials: MT
authors.lastname: Trese
authors.forename: G A
authors.initials: GA
authors.lastname: Williams
authors.forename: P J
authors.initials: PJ
authors.lastname: Ferrone
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D005131:Eye Injuries / Q000209:etiology / Q000628:therapy*; D005260:Female; D005341:Fibrinolysin / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012160:Retina / Q000293:injuries*; D012167:Retinal Perforations / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D005341:Fibrinolysin