Fibrin-Glue-Assisted Surgery for Idiopathic Macular Holes

Abstract

ABSTRACT Pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) and gas tamponade has been the standard of care for idiopathic macular holes (MHs). However, the use of tamponades like intraocular gases has their associated complications and more importantly a need for postoperative positioning which can be a challenge in elderly and people with orthopaedic problems. This study describes a novel surgical technique of utilising fibrin glue to obviate the problems associated with conventional gas tamponade and also to help in avoiding any postoperative positioning. Methods This pilot clinical trial included 10 eyes of 10 patients with idiopathic MH, where PPV along with ILMP was done. Fibrin glue was used as a tamponade, and no postoperative positioning was given to any patient. The primary outcome measure was successful anatomical closure of the MH. The secondary outcome measures were postoperative improvement in best-corrected visual acuity (BCVA) and any complications of the procedure. Results The median age of patients was 62.5 years. Eight eyes were pseudophakic and two were phakic. The mean basal diameter of the MH was 1193 microns. The mean minimal linear diameter was 652 microns. Successful anatomic closure of MH was achieved in eight cases. The median BCVA improved from a Snellen equivalent of 20/100 preoperatively to 20/60 at 1 month postoperatively. The median follow-up period was 4 months. Conclusion The findings of this study suggest that the use of fibrin glue can be useful in patients where postoperative positioning is difficult.