Динамика анатомических и функциональных показателей после хирургии сквозных макулярных разрывов большого диаметра

Abstract

Full-thickness macular hole (FTMH) is the macular zone pathology, leading to a significant decrease in visual acuity. According to the literature, classical surgery of FTMH allows to achieve anatomical closure only in 73.3 % of cases. The task of developing a method of surgical treatment of FTMH with the possibility of evaluating its closure intraoperatively is relevant and of strategically important interest for the development of ophthalmic surgery. The purpose of this study is to evaluate the dynamics of functional and anatomical results of large diameter FTMH surgery. Material and methods. A randomized study was conducted on two comparable groups of patients. Surgical treatment of FTMH was performed in both groups, the difference was in the FTMH closure method: in the first group, treatment was carried out according to the proposed method, in the second group, autologous conditioned plasma was used during the surgery. Patients underwent a standard ophthalmological examination, as well as optical coherence tomography of the retina before surgery, 1, 3 and 6 months after surgery. Results and discussion. In the control group, 4 cases of FTMH recurrence were recorded in the postoperative period up to 1 month after surgery. U-shaped closure pattern (Fig. 1) was more often observed in the first group, while in the second group V-shaped closure pattern was more often observed (Fig. 2). Visual acuity 6 months after surgery was higher on average in patients in the first group (p = 0,05). Conclusions. The results obtained indicate a decrease in the risk of recurrence of FTMH, as well as higher visual acuity and close-to-normal retinal histological state in the postoperative period for a period of 6 months when closing the FTMH according to the proposed method. The use of the FTMH closure method under the intraoperative optical coherence tomography control makes it possible to minimize the time of the patient's forced position in the postoperative period, which facilitates its course. Keywords: vitreoretinal surgery, macular hole, optical coherence tomography, autologous conditioned plasma