Клинический анализ эффективности анатомического восстановления фовеолярной сетчатки в витреоретинальной хирургии сквозных макулярных разрывов

Abstract

Purpose. To compare the anatomical and functional results of various techniques macular hole (MH) closure. Material and methods. 24 patients (age from 67 to 81 years; 6 men and 18 women): stage III MH, complete detachment of the posterior hyaloid membrane. MH sizes were from 427x202 to 1392x758 µm. Initial best-corrected visual acuity (BCVA) were from 0.03 to 0.2. Endovitreal intervention 27G with removal of the posterior hyaloid membrane, complete membrane peel was performed. In 18 patients, tamponade was performed with silicone oil, in the remaining 6 patients – with air. 2 groups were formed, comparable in age, sex, MH diameter. In the 1st group (12 patients) vacuum massage was performed, in the 2nd group (12 patients) – partial membrane peel with inverted internal limiting membrane flap technique. Results. All surgery perfomed without complications. In 18 eyes with silicone oil tamponade, all MH were completely closed, BCVA was from 0.15 to 0.5. In 2 of 3 eyes of the 1st group with combination of vacuum massage and pneumotamponade, incomplete closure of the edges of the MH with residual defects 112 µm and 84 µm, respectively, was noted. BCVA ranged from 0.1 to 0.2. In the third case of combination of vacuum massage with pneumotamponade, the MH completely closed, the BCVA increased from 0.2 to 0.6. In all 3 eyes, using the inverted flap technique and pneumotamponade, the MH were completely closed, the BCVA ranged from 0.45 to 0.55. After 1 month after ended of silicone oil tamponade in all 18 patients, the MH were closure, BCVA values increased from 0.25 to 0.5. Conclusion. After a month of follow-up, better anatomical results of complete MH closure were shown by the inverted flap technique in combination with air or silicone oil tamponade. After silicone removal, complete MH closure occurred in 10 eyes of the 1st group and 12 eyes of the 2nd group. In the future, the terms of dynamic observation of these patients will be continued for more objective assessment of the long-term effectiveness of both methods. Keywords: macular hole, vacuum massage, vitreous tamponade