Authors
Larina E.A., Fayzrakhmanov R.R., Pavlovsky O.A.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The aim of this work was to create a technique for the surgical treatment of macular holes that did not close after previous interventions, and to analyze the functional results to evaluate the effectiveness of the proposed technique.
Material and methods. The study included 92 patients with a previously operated unclosed macular hole, divided into 2 groups according to the principle of second surgical treatment: revision of the vitreal cavity + creation of a free flap of the ILM like a “plug” + application of the ACP-mass + tamponade with an air-gas mixture (group 1) or revision of the vitreal cavity + creation of a free flap of the ILM according to the “plug” type + tamponade of the SM (group 2). All patients before reoperation and at various times of postoperative follow-up underwent microperimetry.
Results. In patients of both groups, an increase in visual acuity was noted, however, the functional results in patients of the 1st group turned out to be better than in the group with silicone oil, a year after surgical treatment, visual acuity in the 1st group also turned out to be higher than in the group with tamponade silicone oil by 0.2. The light sensitivity of the macular zone along a small radius after 1-3 months and a year after reoperation in the 1st group was higher than in the 2nd by 2.15 dB and 2.5 dB, respectively.
Conclusion. The technique with the ILM flap in the form of a “plug”, application of the ACP mass and tamponade with an air-gas mixture provides better functional results due to the absence of toxic and mechanical effects of silicon oil, which is confirmed by the data obtained by measuring visual acuity and photosensitivity of the retina, and also eliminates complications, possible with tamponade of the vitreal cavity with silicone oil.
Keywords: macular hole, unclosed, internal limiting membrane, autologous conditioned plasma, microperimetry, light sensitivity.
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