Saratov JOURNAL of Medical and Scientific Research

macular hole

A standardized approach to the choice of basic surgical treatment for large macular holes

Year: 2020, volume 16 Issue: №2 Pages: 687-690
Heading: Ophtalmology Article type: Short message
Authors: Chuprov A.D., Kazennov A.N., Mambetova Е.М.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution
Summary:

The purpose of the study is to optimize the choice of tactics for surgical treatment of large macular holes. Material and Methods. Analysis of the surgical treatment of macular holes in 18 patients (18 eyes) was performed. Patients were divided into 3 groups. Group 1 (8 eyes) included patients with a hole diameter of up to 500±22 urn, group 2 (6 eyes) — with a diameter of up to 800±20 urn, and group 3 (4 eyes) — over 800 urn. In group 1 vitrectomy was performed with peeling of the inner border membrane (IBM), application of platelet rich plasma (PRP) mass and tamponade with air; in the group 2 vitrectomy was performed with IBM peeling, application of PRP mass or closed with a free inverted IBM flap and tamponade with SF6 gas; in group 3 vitrectomy was performed with IBM peeling and closing of the macular holes was performed using a free inverted IBM flap with silicone oil tamponade. Results. There was complete closure of the macular holes with the formation of a normal fovea profile and improvement of visual acuity in all cases of group 1. In group 2 (PRP application) in 2 cases of 6, a second intervention was required with the"plasty" of the macular hole using an inverted IBM flap. In group 3, in 1 case, the gap did not close and in 1 more case it closed with a defect at the level of the ellipsoid zone of the photoreceptors. Conclusion. The preliminary results' analysis showed the effectiveness of the developed algorithm for surgical treatment of macular holes, depending on their diameter, which is optimal and allows obtaining the required anatomical and functional result.

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Dynamics of changes of microperimetry parameters of retina by closure of macular hole with preservation of internal limiting membrane

Year: 2020, volume 16 Issue: №2 Pages: 463-467
Heading: Ophtalmology Article type: Original article
Authors: Pavlovsky О.А., Fayzrakhmanov R.R., Larina Е.А., Sukhanova A.V.
Organization: National Medical and Surgical Center n. a. N. I. Pirogov
Summary:

Objective: To evaluate the medical effectiveness of the macular hole closure (MH) technique, which is based on the limiting of the internal limiting membrane (ILM) peeling. Material and Methods: The results of surgical treatment of 80 patients (80 eyes) diagnosed with MH were analyzed. Patients are divided into two groups: group 1-patients who had a standard peeling; group 2-patients who were operated on using the original method with partial peeling of the macular area. All patients underwent visometry, biomicroscopy, ophthalmoscopy, and OCT-examination. Results: By the 30th day after surgical treatment, a statistically significant excess of light sensitivity parameters was detected in the nasal part of the pattern used: the upper-nasal and lower-nasal quadrants, where peeling was not performed (p=0.032) and (p=0.034), respectively. In the 1st observation group, the recovery of the fixation point was observed during the early and late operating period and at 12 months was 58.3% (p=0.041). In group 2 patients, by the time of 1 month after surgery, the recovery of the fixation point occurred in 88.7%. Conclusion: When conducting the method of limited peeling, the ILM is preserved, which reduces the risk of intraoperative damage to the retina layers. A higher functional result was obtained in comparison with the group where the standard method was used.

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