Saratov JOURNAL of Medical and Scientific Research

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

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.

1. Zhigulin AV, Khudyakov AYu, Lebedev YaB, Mashchenko NV. The effectiveness of silicone tamponade in the surgical treatment of macular holes of large diameter. Fyodorov Journal of Ophthalmic Surgery 2013; 1: 6-8.
2. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: Results of a pilot study. Arch Ophthalmol 1991; (109): 654-9.
3. Madreperla SA, Geiger GL, Funata M, et al. Clinicopath-ologic correlation of a macular hole treated by cortical vitreous peeling and gastamponade. Ophthalmology 1994; (101): 682-6.
4. Method of surgical treatment of macular rupture: Russian patent for invention No. 2407493 dated 27.12.2010/Bikbov MM, Altynbayev UR.
5. Lyskin PV, Zakharov VD, Lozinskaya OL. Pathogenesis and treatment of idiopathic macular holes: Evolution of the question. Fyodorov Journal of Ophthalmic Surgery 2010; (3): 52-5.
6. Spiteri Cornish К, Lois N, Scott N, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database of Systematic Reviews 2013; (6). DOI: 10.1002/14651858. CD009306. pub2.
7. Shin M, Park K, Park S, Byon I, Lee J. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery. Retina 2014; 34 (9): 1905-10.
8. Yooh JS, Brooks HL, Capone AJr, et al. Ultrastructural features of tissue removed during idiopathic macular hole surgery. Am J Ophthalmol 1996; (122): 67-75.
9. Shkvorchenko DO, Khoroshilova-Maslova IP, Andreeva LD, et al. Surgical treatment of idiopathic macular holes with removal of the inner bordering membrane of the retina. In proceedings of All-Russian scientific and research conference "Current technologies of vitreoretinal pathology treatment". Moscow, 2002: 338-346.
10. Chen SN, Yang СМ. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies. Retina 2016; 36 (1): 163-70.
11. Benson WE, Cruckshanks КС, Fong DC, et al. Surgical management of macular holes: a report by the American Academy of Ophthalmology. Ophthalmology 2001; (108): 1328-35.
12. Lois N, BurrJ, Norrie J, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial. Invest Ophthalmol VisSci. 2011; 52(3): 1586-92.
13. Paques M, Massin P, Santiago PY, et al. Late reopening of successfully treated macular holes. Br J Ophthalmol 1997; 81 (8): 658-62.
14. Brooks HL. Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology 2000; (107): 1939-49.
15. Alpatov SA, Shchuko AG, Malyshev VV. Pathogenesis and treatment of idiopathic macular holes. Novosibirsk: Nauka, 2005; 136 p.
16. Couvillion SS, Smiddy WE, Flynn HW, et al. Outcomes of surgery for idiopathic macular hole: A case-control study comparing silicone oil with gas tamponade. Ophthalmic Surg Lasers Imaging Retina 2005; 36 (5):365-71.
17. Gekka T, Watanabe A, Ohkuma Y, et al. Pedicle internal limiting membrane transposition flap technique for refractory macular hole. Ophthalmic Surg lasers Imaging Retina 2015; 46 (10): 1045-6.
18. A method for surgical treatment of penetrating idiopathic macular rupture: Russian patent for invention No. 2395255 dated 27.07.2010/Belyy YuA, Tereshchenko AV.
19. MichalewskaZ, Michalewska J, Dulczewska-Cichecka К, et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina 2015; 35 (9): 1844-50.
20. Shilov NM, Tereshchenko AV, Trifanenkova IG. Modification of the technology for closure of large idiopathic macular ruptures using the method of step formation of a fragment of the internal boundary membrane. Current Technologies in Ophthalmology 2017; 5 (18): 79-82.

2020_02-1_687-690.pdf306.57 KB

No votes yet