MACULAR HOLE SURGERY USING THROMBIN-ACTIVATED FIBRINOGEN AND SELECTIVE REMOVAL OF THE INTERNAL LIMITING MEMBRANE

Purpose: To evaluate a tissue sealant (autologous cryoprecipitate acti vated with bovine thrombin) as an adjuvant in macular hole surgery. Me thods: Sixty-nine patients with stage 2, 3, or 4 full-thickness macula r hole were enrolled consecutively in a prospective pilot study. Anato mic closure of the macular holes with a single operation was the prima ry outcome. Fifty-eight patients had pre- and postoperative standardiz ed measurements including best refracted visual acuity, reading speed, and contrast sensitivity. Group A patients (45) had primary macular h oles; Group B patients (13) had recurrent macular holes or macular hol es with ''other'' retinal pathology. Surgical technique was standardiz ed and membrane dissections were optional. Results: The anatomic closu re 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 be tter than for Group B (0.8 +/- 0.5 lines; P = 0.008). Eyes that underw ent internal limiting membrane (ILM) dissections had an anatomic closu re rate of 96% (23/24),compared with 71% (32/45) in ''non-ILM'' cases (P = 0.034). Adverse reactions included sterile hypopyon (10%), intrar etinal hemorrhage (9%), pigmentary hyperplasia (3%), and retinal detac hment (3%). Conclusion: Tissue sealants should be evaluated as an adju vant in macular hole surgery in a randomized clinical trial. inflammat ory reactions may occur in some patients, Internal limiting membrane d issection may improve anatomic closure rates without adversely affecti ng the visual acuity.