DOI: 10.25881/20728255_2022_17_4_S1_37

Authors

Larina E.A., Fayzrakhmanov R.R., Pavlovsky O.A.

Pirogov National Medical and Surgical Center, Moscow

Abstract

The aim of this work was to create a technique for the surgical treatment of macular holes that did not close after previous interventions, and to analyze the functional results to evaluate the effectiveness of the proposed technique.

Material and methods. The study included 92 patients with a previously operated unclosed macular hole, divided into 2 groups according to the principle of second surgical treatment: revision of the vitreal cavity + creation of a free flap of the ILM like a “plug” + application of the ACP-mass + tamponade with an air-gas mixture (group 1) or revision of the vitreal cavity + creation of a free flap of the ILM according to the “plug” type + tamponade of the SM (group 2). All patients before reoperation and at various times of postoperative follow-up underwent microperimetry.

Results. In patients of both groups, an increase in visual acuity was noted, however, the functional results in patients of the 1st group turned out to be better than in the group with silicone oil, a year after surgical treatment, visual acuity in the 1st group also turned out to be higher than in the group with tamponade silicone oil by 0.2. The light sensitivity of the macular zone along a small radius after 1-3 months and a year after reoperation in the 1st group was higher than in the 2nd by 2.15 dB and 2.5 dB, respectively.

Conclusion. The technique with the ILM flap in the form of a “plug”, application of the ACP mass and tamponade with an air-gas mixture provides better functional results due to the absence of toxic and mechanical effects of silicon oil, which is confirmed by the data obtained by measuring visual acuity and photosensitivity of the retina, and also eliminates complications, possible with tamponade of the vitreal cavity with silicone oil.

Keywords: macular hole, unclosed, internal limiting membrane, autologous conditioned plasma, microperimetry, light sensitivity.

References

1. Samoilov A.N., Mukhametzyanova G.M. Experience in surgical treatment of large-diameter idiopathic macular holes. Sovremennye tekhnologii v oftal’mologii. 2017; 1:259-261 (In Russ.)

2. Neroev V.V. Analysis of primary ophthalmic health care in the Russian Federation. Rossijskaya oftal’mologiya onlajn. 2016; 23 (In Russ.)

3. Lyskin P.V., Zakharov V.D., Lozinskaya O.L. Pathogenesis and treatment of idiopathic macular holes. The evolution of the issue. Oftal’mohirurgiya. 2010;3:52-55 (In Russ.)

4. McCannel C.A., Ensminger J.L., Diehl N.N., Hodge D.N. Population-based incidence of macular holes. Ophthalmology. 2009; 7:1366-1369.

5. Shkvorchenko D.O., Zakharov V.D., Krupina E.A., Pismenskaya V.A., Kakunina S.A., Norman K.S., Petersen E.V. Surgical treatment of primary macular rupture using platelet-rich plasma. Oftal’mohirurgiya. 2017;3:27-30. (In Russ.)

6. Faizrakhmanov R.R., Bosov E.D., Shishkin M.M. et al. Modern aspects of the treatment of submacular hemorrhages against the background of macular degeneration. Vestnik ophthalmologii. 2022. V. 138. No. 2. S. 87-93 (In Russ.)

7. Bayborodov Ya.V. Anatomical and functional results of the use of various techniques for the surgical closure of macular holes. Sovremennye tekhnologii v oftal’mologii.2015;1: 22-24 (In Russ.)

8. Alpatov S.A., Shchuko A.G., Malysheva V.V. Features of 23G macular hole surgery. Sovremennye tekhnologii lecheniya vitreoretinal’noj patologii. — Vitreoretinal’nyj klub. 2008: 12–14 (In Russ.)

9. Fayzrakhmanov R.R., Voropaev V.Yu., Sukhanova A.V. et al. Antiangiogenic therapy for neovascular age-related macular degeneration.Vestnik of ophthalmologii. 2021. V. 137. No. 1. S. 83-93 (In Russ.)

10. Kelly N.E., Wendel RT., Kase S., Saito W., Mori S., et al. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991; 109: 654–659.

11. Fayzrakhmanov R.R., Pavlovsky O.A., Larina E.A. A method for closing macular holes with partial preservation of the inner limiting membrane. Vestnik oftal’mologii. 2020; 1:73-79 (In Russ.)

12. Neelam K., O’Gorman N., Nolan J. Macular pigment levels following successful macular hole surgery. // Br J Ophthalmol. 2005;9: 1105-1108.

13. Abdelkader E., Lois N. Internal limiting membrane peeling in vitreo-retinal surgery. Surv Ophthalmol. 2008; 4: Р. 368–396.

14. Chekhonin E.S., Fayzrakhmanov R.R., Sukhanova A.V. et al. Anti-VEGF drugs in the treatment of diabetic retinopathy. Vestnik ophthalmologii. 2021. V. 137. No. 4. S. 136-142. (In Russ.)

15. Theodossiadis G., Petrou P., Eleftheriadou M. et al. Focal vitreomacular traction: а prospective study of the evolution to macular hole: the mathematical approach. Eye. 2014; 12:1452-1460

16. Essex RW, Kingston ZS, Moreno-Betancur M, et al. The effect of postoperative face-down positioning and of long-versus short-acting gas in macular hole surgery: results of a registry-based study.Ophthalmology. 2016; 5: 1129–1136.

17. Khudyakov A.Yu., Zhigulin A.V. Comparative analysis of the results of surgical treatment of large diameter macular holes using air and silicone tamponade. Sovremennye tekhnologii v oftal’mologii. 2018;1:388-390 (In Russ.)

18. Jackson T.L., Donachie P.H.J., Sparrow J.M., Johnston R.L. United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole. Ophthalmology. 2013; 3: 629–634.

19. Rahimy E., McCannel C.A. Impact of internal limiting membrane peeling on macular hole reopening: A Systematic Review and Meta-Analysis. Retina. 2016; 4: 679-87.

20. Ullrich S., Haritoglou C., Gass C., et al. Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol. 2002; 86 : 390-393.

21. Kanovsky R., Jurecka T., Gelnarova E. Analysis of prognostic factors of anatomical and functional results of idiopathic macular hole surgeryю Cesk. Slov. Oftalmol. 2009;3: 91-96.

22. Zhigulin A.V., Khudyakov A.Yu., Mashchenko N.V. The effectiveness of surgical treatment of idiopathic macular holes depending on the diameter of the gap. Novye tekhnologii diagnostiki i lecheniya zabolevanij organa zreniya v Dal’nevostochnom regione. 2013: 256 (In Russ.)

23. Ip M., Baker В.J., Duker J.S., Reichel E. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch. Ophthalmol. 2002;1: 29-35.

24. Shpak A.A., Shkvorchenko D.O., Sharafetdinov I.Kh., Yukhanova O.A. Predicting the results of surgical treatment of idiopathic macular rupture. Oftal’mohirurgiya. 2015;2:55-61 (In Russ.)

25. Konovalov M.E., Kozhukhov A.A., Zenina M.L., Gorenskii A.A. A method for re-closing unclosed macular holes. Sovremennye tekhnologii v oftal’mologii. 2016; 1:306-308.

26. Morizane Y., Shiraga F., Kimura S. et al. Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Holes. Am. J. Ophthalmol. 2014; 4: 861-869.

27. Tereshchenko A.V., Trifanenkova I.G., Shpak A.A., Shilov N.M. Predicting the anatomical outcome of surgical treatment of large idiopathic macular holes. Oftal’mologiya, prakticheskaya medicina. 2017; 9:222-226 (In Russ.)

For citation

Larina E.A., Fayzrakhmanov R.R., Pavlovsky O.A. Changes in photosensitivity of the central retina in patients after reoperation for recurrent macular rupture. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(4,supplement):37-41. (In Russ.) https://doi.org/10.25881/20728255_2022_17_4_S1_37