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[The method of closing macular holes with partial preservation of the internal limiting membrane]
R R Fayzrakhmanov1, O A Pavlovskiy1, E A Larina1
1National Medical and Surgical Center named after N.I. Pirogov, the Ministry of Healthcare of the Russian Federation, 70 Nizhnyaya Pervomayskaya St., Moscow, Russian Federation, 105203.
Abstract:
Macular hole is an urgent vision impairment problem among the population of developed countries. The main method of treatment of the macular hole is vitrectomy with removal of the internal limiting membrane (ILM). However, the pilling has been recently proved to have negative impact on neurophysiological processes in the macular zone.
Purpose:
To suggest a new technique and to evaluate the dynamics of anatomical and functional parameters after surgery for macular hole with preservation of ILM.
Material And Methods:
The study examined the results of treatment of 52 patients (52 eyes) with end-to-end macular holes of stages 2 to 4 according to the Gass classification. Patients of the 1st group underwent standard surgical treatment: vitrectomy and then circular maculorhexis. Patients of group 2 were operated according to the original method with partial preservation of ILM in the foveolar zone. All patients underwent standard ophthalmological examination before and after the surgery. The morphometric data was evaluated using optical coherence tomography (OCT). Statistical processing of the results was carried out using IBM SPSS Statistics 23 software.
Results:
Morphofunctional parameters of the retina did not differ between patients of the two groups before treatment. According to the results of surgical treatment, on day 7 after the operation, higher indices of functional parameters of the retina were observed in patients of the 2nd group. On day 30, patients of group 2 were observed to have an increase in best-corrected visual acuity (BCVA) in comparison with these indicators on day 7, and a significant increase in comparison with the data before surgery. In patients of group 1, no improvement of vision was observed. It was also revealed that holes with permanent cystic cavities have the worst prognoses in terms of increasing visual functions and restoring the foveolar profile.
Conclusion:
The described procedure allows partial preservation of ILM, which reduces the risk of intraoperative damage to the retinal layers; the observed functional results were higher.
