Authors
Vaganova Е.Е., Larina E.A.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Rationale: Rhegmatogenous retinal detachment, complicated by macular hole, is a severe, widespread disease that leads to an irreversible decrease in visual function. When discussing the modern approach to macular surgery, much attention is paid to the volume of membrane peeling and mechanical damage to retinal tissue in the foveal zone. Even when this manipulation is performed by an experienced surgeon, the end plates of Müller cells inevitably tear off and the layer of nerve fibers becomes rarefied.
Objective: to analyze the dynamics of changing of the morphological parameters of the retina of patients after surgical treatment of rhegmatogenous detachment complicated by macular hole with preservation of the internal limiting membrane.
Methods: Data from 40 patients (40 eyes) diagnosed with retinal detachment with macular hole stage C proliferative vitreoretinopathy were prospectively studied. Patients of group 1 (20 patients, 20 eyes) underwent surgical treatment, including three-port 25G vitrectomy, Perfluoroorganic compound was used, sanitation of the vitreous in the periphery and silicone tamponade were performed. Membrane peeling is performed during the second operation to remove silicone. During the first intervention, patients of the 2nd group underwent vitrectomy, staining of the internal limiting membrane under a layer of perfluoroorganic compound and membrane peeling under a layer of perfluoroorganic compound with closure of the hole with an inverted flap and sanitation of the vitreous in the periphery. The operation was also completed with silicone tamponade. During the second intervention, the SM was removed from the vitreal cavity.
Results: During the observation period, cases of a decrease in the diameter of the intact macular hole and its complete closure under the influence of silicone tamponade were recorded in patients of group 1. One day after surgery, the hole closed on its own in 2 patients (10%) cases, in the remaining 18 (90% of cases) there was a significant decrease in its diameter to 224±33.6 µm. During the examination before the second operation in the 1st group, 3 patients with macular hole on average 89±17.7 μm were recorded; they underwent membrane peeling during surgery to remove the silicone oil.
When analyzing data on the thickness of the inner layers of the retina, significant differences are observed in the parafovea and perifovea zones during the first week after surgical treatment. On the first day after membrane peeling, in patients of the 2nd group, in all segments of the para- and perifoveal zone, a significant decrease in the thickness of the inner layers of the retina was observed in comparison with the data of patients of the 1st group.
Conclusions: Based on the analysis of the dynamics of the anatomical parameters of the retina of patients after surgical treatment of retinal detachment with macular hole, it should be noted that refusal to perform membrane peeling on the detached retina during the first stage of surgical intervention allows one to avoid aggressive mechanical trauma to the retinal tissue due to its mobility. During the second stage of surgical treatment, when the retina is already firmly attached to the choroid, membrane peeling is safer.
Keywords: rhegmatogenous retinal detachment, macular hole, membrane peeling.
References
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