fficacy of autologous plasmin for idiopathic macular hole surg

There is good evidence that macular holes (MHs) result from tangential traction of the vitreous on the macular region (1, 2). In some cases, there is evidence that a contraction of a fibrous membrane consisting of glial cells and the internal limiting membrane (ILM) surrounding the hole can lead to MHs (3, 4). Thus, the successful closure of MHs should be achieved by creating a posterior vitreous detachment (PVD) (5, 6) or by removing the ILM (7-12) in these cases. H o w e v e r, even if there is a closure of the MH following these surgical pro c e d u res, surgical complications may occ u r, such as formation of retinal tears (13-15), visual field loss (16, 17), maculopathy due to light damage (18), c h o roidal neovascularization (19), and failure to improve vision (20). In addition, the face-down position that the patient must maintain following the injection of gas for tamponading the retina is a significant strain on the patient. Some of these complications can be reduced if a PVD is already created and if the operation time is shortened. The concept of pharmacologic vitrectomy with plasmin PU R P O S E. To determine whether a single intravitreal injection of autologous plasmin or a combination of plasmin and intraocular gas without peeling the internal limiting membrane (ILM) will close idiopathic macular holes. ME T H O D S. Eight eyes of seven patients with an idiopathic macular hole were studied. The d e g ree of posterior vitreous detachment (PVD), vitreal liquefaction, closure of the macular hole, visual acuity, and complications following intravitreal plasmin or plasmin with gas were investigated. The removed ILM was examined by electron microscopy. RE S U LT S. A PVD was created in seven out of eight eyes exposed to plasmin or plasmin with gas, however, the macular hole was not closed by either. Closure occurred in two eyes using conventional vitrectomy after the plasmin with gas injection, but peeling the ILM was re q u i red in the remaining six eyes. Vi t real fibers and glial cells were not observed on the v i t real surface of the extracted ILM. CO N C L U S I O N S. A PVD was created safely and reliably although closure of the macular hole did not occur with either plasmin or with plasmin and gas injection. However, vitreous surgery became easier, and it re q u i red a shorter time to close the macular hole with intravitreal plasmin. (Eur J Ophthalmol 2005; 15: 7 8 79 4 )