Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane.
OBJECTIVE
To evaluate a tissue sealant (autologous cryoprecipitate activated with bovine thrombin) as an adjuvant in macular hole surgery.


METHODS
Sixty-nine patients with stage 2, 3, or 4 full-thickness macular hole were enrolled consecutively in a prospective pilot study. Anatomic closure of the macular holes with a single operation was the primary outcome. Fifty-eight patients had pre- and postoperative standardized measurements including best refracted visual acuity, reading speed, and contrast sensitivity. Group A patients (45) had primary macular holes; Group B patients (13) had recurrent macular holes or macular holes with "other" retinal pathology. Surgical technique was standardized and membrane dissections were optional.


RESULTS
The anatomic closure rate was 80% with a minimum of 6 months follow-up. Mean improvement in visual acuity for Group A (2.9+/-0.4 lines) was significantly better than for Group B (0.8+/-0.5 lines; P = 0.008). Eyes that underwent internal limiting membrane (ILM) dissections had an anatomic closure rate of 96% (23/24), compared with 71% (32/45) in "non-ILM" cases (P = 0.034). Adverse reactions included sterile hypopyon (10%), intraretinal hemorrhage (9%), pigmentary hyperplasia (3%), and retinal detachment (3%).


CONCLUSIONS
Tissue sealants should be evaluated as an adjuvant in macular hole surgery in a randomized clinical trial. Inflammatory reactions may occur in some patients. Internal limiting membrane dissection may improve anatomic closure rates without adversely affecting the visual acuity.
Olsen
T W
TW
Department of Ophthalmology, Emory University, Atlanta, Georgia 30322, USA.
Sternberg
P
P
Capone
A
A
Martin
D F
DF
Lim
J I
JI
Grossniklaus
H E
HE
Aaberg
T M
TM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015350:Contrast Sensitivity; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage* / Q000009:adverse effects; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011932:Reading; D012167:Retinal Perforations / Q000601:surgery* / Q000628:therapy; D013917:Thrombin / Q000008:administration & dosage* / Q000009:adverse effects; D014014:Tissue Adhesives / Q000009:adverse effects; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
D015718:Fibrin Tissue Adhesive; D005466:Fluorocarbons; D014014:Tissue Adhesives; C042852:perflutren; D013917:Thrombin