Послеоперационные особенности структуры фовеолярной области после хирургического лечения сквозных макулярных разрывов различными способами

Abstract

Purpose. Comparative assessment of the retinal macular zone structure after surgical treatment of full-thickness macular hole (FTMH) by various methods. Material and methods. Patients with Gass stage III-IV FTMH were divided into 3 groups. Group 1 patients (20 eyes) underwent a standard operation (subtotal vitrectomy (sVE), aspiration convergence of the FTMH edges, gas-air tamponade of the vitreous cavity). Patients in group 2 (20 eyes), after sVE and ILM peeling, autologous conditioned plasma (ACP) were applied to FTMH area followed by air tamponade. Patients of group 3 (20 eyes) after sVE underwent FTMH closure using an inverted ILM flap with the rupture edges approached, followed by air tamponade. Results. The increase in BCVA after 1 month averaged from 0.23±0.1 to 0.41±0.13, (p<0.05) in patients in group 1, in group 2 from 0.15±0, 07 to 0.75±0.09, (p<0.05), in patients in group 3 from 0.14±0.05 to 0.78±0.08, (p<0.05). Anatomical results: in group 1, 17 patients who received standard surgical treatment, a month after surgery, had a satisfactory anatomical result (complete closure of the FTMH with restoration of the correct retinal architectonics in the foveal zone). In 3 patients, additional endovitreal intervention was required with successful FTMH closure. In all patients in group 2, according to OCT data, 5 days after the operation, hyperreflective tissue was detected in the FTMH area ("platelet plug"). When OCT was performed 1 month later, in all cases, the platelet plug resolved, and in all cases, restoration of the foveal profile architectonics was observed. In group 3, the closure of the FTMH on the 5th day of observation was recorded in all patients. When performing OCT after 1 month, complete closure of the neuroepithelium layer was recorded in all cases: in 13 patients - U-shaped closure and in 7 cases – V-shaped. The functional results in both groups were comparable; there was no statistical difference between them. Conclusion: The data obtained demonstrate the morphological features of the retinal foveolar zone postoperative restoration. There was no significant difference in functional results between study groups. Key words: full-thickness macular hole, vitreoretinal surgery, internal limiting membrane, inverted ILM flap, autologous conditioned plasma, optical coherence tomography.