Document Detail

Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane.
MedLine Citation:
PMID:  9730174     Owner:  NLM     Status:  MEDLINE    
PURPOSE: 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%). CONCLUSION: 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.
T W Olsen; P Sternberg; A Capone; D F Martin; J I Lim; H E Grossniklaus; T M Aaberg
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Retina (Philadelphia, Pa.)     Volume:  18     ISSN:  0275-004X     ISO Abbreviation:  Retina (Philadelphia, Pa.)     Publication Date:  1998  
Date Detail:
Created Date:  1998-10-28     Completed Date:  1998-10-28     Revised Date:  2008-05-30    
Medline Journal Info:
Nlm Unique ID:  8309919     Medline TA:  Retina     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  322-9     Citation Subset:  IM    
Department of Ophthalmology, Emory University, Atlanta, Georgia 30322, USA.
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MeSH Terms
Aged, 80 and over
Contrast Sensitivity
Epiretinal Membrane / surgery*
Fibrin Tissue Adhesive / administration & dosage*,  adverse effects
Fluorocarbons / administration & dosage
Middle Aged
Pilot Projects
Prospective Studies
Retinal Perforations / surgery*,  therapy
Thrombin / administration & dosage*,  adverse effects
Tissue Adhesives* / adverse effects
Treatment Outcome
Visual Acuity
Reg. No./Substance:
0/Fibrin Tissue Adhesive; 0/Fluorocarbons; 0/Tissue Adhesives; 76-19-7/perflutren; EC
Comment In:
Retina. 1999;19(5):478-9   [PMID:  10546957 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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