THROMBIN IN THE MANAGEMENT OF FULL-THICKNESS MACULAR HOLES

Purpose: As thrombin is a known stimulator of retinal glial and pigmen t epithelial cells, we performed a pilot study to evaluate the use of thrombin as adjunctive mitogen therapy in vitreous surgery for full-th ickness macular holes. Methods: Macular hole surgery was performed on 25 eyes of 24 consecutive patients with stage II, III, or IV macular h oles. After removal of the posterior hyaloid, peeling of epiretinal me mbranes, and fluid-air exchange, 0.05 mL or 0.1 mL of thrombin (100 un its/mL) was placed over the macular hole. After infusion of a gas tamp onade, the patient's head was kept in a supine position for 1 hour, an d then was kept in a prone position for approximately 2 weeks. Results : Closure of the macular hole with one procedure was achieved in 80% o f the eyes. Sixty-five percent of the eyes with a closed macular hole achieved a visual acuity of 20/40 or better. Postoperative inflammatio n was present in all eyes, and a small hypopyon developed in 28% of th e eyes. Conclusion: Thrombin therapy failed to markedly increase the s uccess rate of macular hole surgery.