PLASMIN ENZYME-ASSISTED VITRECTOMY IN TRAUMATIC PEDIATRIC MACULAR HOLES

Objective: This study aimed to evaluate the benefit of plasmin enzyme- assisted macular hole surgery on a consecutive series of pediatric pat ients with traumatic macular holes. Design: 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. Part icipants: During this interval, the authors operated on four eyes from four consecutive patients who were 14 years of age or younger with tr aumatic macular holes. Intervention: The patients underwent plasmin en zyme-assisted pars plana vitrectomy with membrane peeling, fluid-gas e xchange, and postoperative positioning, The enzyme used was 0.4 intern ational unit (IU) of autologous plasmin enzyme.Main Outcome Measures: Snellen lines of improvement in visual acuity and rate of final visual acuity of 20/40 or greater, and incidence of complications and reoper ations were measured. Results: All four macular holes were closed succ essfully. Follow-up was from 6 to 12 months. There were no reoperation s. 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 devel op: two of the eyes after surgery and one as a result of the initial i njury. Conclusion: The treatment of pediatric traumatic macular holes with plasmin enzyme-assisted vitrectomy, membrane peeling, and gas-flu id exchange resulted in closure of the macular holes with significant visual improvement.