Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane

Timothy W. Olsen, Paul Sternberg, Antonio Capone, Daniel F. Martin, Jennifer I. Lim, Hans E. Grossniklaus, Thomas M. Aaberg

Research output: Contribution to journalArticlepeer-review

127 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)322-329
Number of pages8
Issue number4
StatePublished - 1998


  • Autologous cryoprecipitate
  • Bovine thrombin
  • Fibrin sealants
  • Macular hole
  • Pars plana vitrectomy

ASJC Scopus subject areas

  • Ophthalmology


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