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Baha El Khatib, Kyle Hirabayashi, Sam Edward Mansour; Large Macular Hole Closure Outcomes Following Tisseel Fibrin Sealant with Silicone Oil and Gas Injection. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4395.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the anatomic closure rate in primary and secondary large full thickness macular hole surgery using Tisseel (Baxter Healthcare Corp., Deerfield, IL) fibrin sealant.
This study was in accordance with HIPAA regulations, and adhered to the Declaration of Helsinki and all federal and state laws. Institutional review board approval was obtained. A retrospective chart review was carried out for 29 eyes in 29 patients that underwent large full thickness macular hole (FTMH) surgery with Tisseel fibrin sealant between 2010 and 2017 with one surgeon at The George Washington University and Virginia Retina Center.Large FTMH repair with Tisseel fibrin sealant involved performing a pars plana vitrectomy (PPV), elevating the hyaloid, peeling the internal limiting membrane (ILM), conducting air-fluid exchange, placing the Tisseel sealant over the hole and macula for approximately 10 minutes, and then exchanging air for gas or silicone oil.
Of the 29 patients (29 eyes) who underwent large full thickness macular hole surgery with Tisseel fibrin sealant, 19 (65.6%) were female and 10 (34.5%) were male with an average age of 64.4 ± 11.8 (SD). Overall closure rate of those eyes undergoing macular hole repair with Tisseel sealant was 55.2% (n = 16). 13 eyes underwent primary macular hole repair (macular hole surgery for the first time). 19 eyes underwent secondary macular hole repair (macular hole surgery for the second time). Closure rates for primary vs secondary macular hole surgery with Tisseel sealant was 76.9% (n=10) and 31.6% (n=6) respectively (p= 0.20).
Large full thickness macular hole repair is quite successful with anatomic closure rates ranging from 75% to 100% for primary surgery and 46.7% to 100% for secondary surgery. This retrospective chart review study suggests that the addition of Tisseel fibrin sealant to primary large FTMH repair meets the success rates of the standard of care with closure rates of 76.9%. While secondary large FTMH repair with the addition of Tisseel fibrin sealant may not meet the success rates of the standard of care, with closure rates of 31.6%. Limitations of this study include retrospective analysis, small sample size, and incomplete follow up.
This is a 2020 ARVO Annual Meeting abstract.
Patient OCT showing a large full thickness macular hole.
Patient OCT showing a large full thickness macular hole after repair with Tisseel fibrin sealant.
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