The use of autologous fibrinogen and bovine thrombin to close full-thickness macular holes

Purpose. To investigate the surgical technique, outcome, and possible adverse reactions involved with the closure of full-thickness macular holes using autologous fibrinogen and bovine thrombin. Methods. A pilot study including a consecutive series of patients with full-thickness macular holes. Gass stage II-IV macular holes from 2 months to 3 years duration were included. Preoperative standardized vision (MPS vision, reading speed, and contrast sensitivity) with a minimum follow-up of 3 months is available on 37 patients. Pars plana vitrectomy with separation of the cortical vitreous, optional membrane stripping, and air-fluid exchange with 15 minutes of vitreous dehydration was performed. One to 2 drops (80-100 U) of bovine thrombin (Thrombinar®) was placed over the hole with 1-2 drops of autologous cryoprecipitate, followed by a 10% C₃F₈ gas exchange. Face-down positioning was strongly encouraged for 2 weeks. Standardized testing was done at 1, 3, and 6 months postoperatively. Results. Of the 37 operative eyes, anatomic closure of the macular hole was achieved in 30 eyes (81%). In the 30 eyes with anatomic success, vision improved by a mean of 3 lines, (8/30 patients had > 4 line improvement), reading speed increased by 2 seconds on average (8/30 patients had ≥ 5 second improvement), and contrast sensitivity increased by 2 letters on average (5 patients with ≥ 5 letters improvement). Adverse reactions included postoperative hypopyon (3/37 = 8%), intraretinal hemorrhage (7/37 = 19%), and retinal detachment (1/37). Conclusion. Autologous fibrinogen and bovine thrombin may be beneficial for the closure of macular holes. Postoperative hypopyon and intraocular inflammation should be monitored cautiously. The potential benefits of autologous fibrinogen over other agents or the use of positioning alone requires further investigation.