DOI: 10.25881/20728255_2024_19_4_S1_129

Authors

Vaganova Е.Е., Кonovalova К.I.

Pirogov National Medical and Surgical Center, Moscow

Abstract

Rationale: Macular hole is a defect of the retina in the foveolar zone. In combination with rhegmatogenous retinal detachment, this disease can lead to irreversible deterioration of visual functions and requires immediate surgical treatment. One of the trends in modern ophthalmic surgery is to increase the area of preservation of the internal limiting membrane during the macular hole blocking. Despite this, microperimetry data indicate the appearance of microscotomas at the point of peeling initiation and a general decrease in the photosensitivity of the retinal tissue in the membrane removal zone.

Objective: to analyze the dynamics of changes in the retinal functional parameters of patients with macular hole and rhegmatogenous retinal detachment according to microperimetry data after surgical treatment in the late postoperative period.

Methods: Data from 40 patients (40 eyes) diagnosed with macular hole and rhegmatogenous retinal detachment were prospectively studied. Patients in group 1 (20 patients, 20 eyes) underwent surgical treatment, including three-port 25G vitrectomy, perfluoroorganic compound, vitreous body sanitation at the periphery, and silicone tamponade. Membrane peeling was performed during the second operation to remove silicone. Patients in group 2 underwent vitrectomy, membrane staining under the perfluorine layer, membrane peeling with closure of the macular hole with an inverted flap, vitreous body sanitation during the first intervention. The operation was also completed with silicone tamponade. During the second intervention, silicone oil was removed from the vitreous cavity.

Results: When comparing the light sensitivity index of the retinal tissue in the foveolar zone between the groups, a reliable difference in the indices by 1.2 times continued to persist up to one and a half years after the final stage of surgical treatment, there was a predominance of values in patients of the 1st group with a completely preserved membrane (p = 0.043 in comparison with the data of patients of the 2nd group). In three peripheral zones of the macula, during the long-term observation period up to one and a half years after surgery, the indices of patients of the 1st group prevailed by 1.5 times (p = 0.041 in comparison with the data of patients of the 2nd group).

Conclusion: based on the analysis of the dynamics of the functional indices of the retina of patients after surgical treatment of macular hole in combination with rhegmatogenous retinal detachment, the refusal to perform membrane peeling on the detached retina during the first stage of surgical intervention allows to avoid aggressive mechanical trauma to the retinal tissue.

Keywords: rhegmatogenous retinal detachment, macular hole, membrane peeling, internal limiting membrane.

References

1. Khaibrakhmanov TR, Samoylov AN. Surgery of large diameter full-thickness macular holes in high myopia. Russian National Ophthalmological Forum. – 2022. – Vol. 1. – P. 215-216. (in Russ.)

2. Cho H, Choi A, Woong Kang S. Effect of internal limiting membrane removal in treatment of retinal detachment caused by myopic macular hole. Korean Journal of Ophthalmology. – 2004. – Vol. 18, №2. – Р.141–147.

3. Chen S, Hsieh Y, Yang C. Multiple free internal limiting membrane flap insertion in the treatment of macular hole-associated retinal detachment in high myopia. Ophthalmologica. – 2018. – Vol.240, №3. – Р.143–149.

4. Sukhanova AV, Fayzrakhmanov RR, Pavlovsky OA et all. Dynamics of sensitivity parameters of the central retinal zone after vitrectomy for rhegmatogenous retinal detachment using silicone oil tamponade. Saratov J Med Sci Res. – 2021. – Vol. 17, № 2. – P. 383-388. (in Russ)

5. Oh H. Idiopathic macular hole. Developments in ophthalmology. – 2014. – №54. – P.150–158.

6. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J.Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. – 2010. – Vol. 10, № 117. – P. 2018–2025.

7. Fayzrakhmanov RR, Pavlovsky OA, Larina EA The method of closure of macular holes with a partial peeling of the internal limiting membtane: comparative analisis. Medline.ru. 2019;20:187-200. (in Russ.)

8. Patent № 2617528 S1 Rossiiskaya Federatsiya, MPK A61F 9/007 (2006.01). Method for large idiopathic macular breakdowns surgical treatment using “internal border membrane reversed flap” technique: № 2016111238 : zayavl. 25.03.2016 : opubl. 25.04.2017 Byul. № 12 / Kazaikin V. N., Novoselova T. N. ; zayavitel’ AO «Ekaterinburgskii tsentr MNTK “Mikrokhirurgiya glaza” (In Russ.)

9. Patent № 2715989 C2 Rossiiskaya Federatsiya, MPK A61F 9/008 Method for surgical treatment of a full macular hole, which has caused rhegmatogenous retina detachment № 2019120761 : zayavl. 01.07.2019 : opubl. 04.03.2020 / Samoilov A.N., Khaibrakhmanov T.R., Fazleeva G.A., Samoilova P.A., Fazleeva M.A. ; zayavitel’ Federal’noe gosudarstvennoe byudzhetnoe obrazovatel’noe uchrezhdenie vysshego obrazovaniya “Kazanskii gosudarstvennyi meditsinskii universitet” Ministerstva zdravookhraneniya Rossiiskoi Federatsii. (In Russ.)

10. Fayzrakhmanov RR, Larina EA, Pavlovskiy OA. Microperimetry as a tool to assess retinal functional parameters in patients with recurrent macular hole. Russian Journal of Clinical Ophthalmology. – 2020. – Vol. 20, №2. – P. 51-55. (in Russ.)

11. Khaibrakhmanov TR, Samoylov AN, Tumanova PA, Khaibrakhmanova GA. Results of various approaches to the surgical treatment of large full-thickness macular holes. Bulletin of the National Medical and Surgical N.I. Pirogov Center. – 2023. – Vol. 18, № 3. – P. 104-107 (in Russ.)

12. Larina EA, Fayzrakhmanov RR, Pavlovsky OA. Comparative analysis of morphological and functional methods of studying the condition of the central parts of the retina during relapse of macular rupture. Modern technology in ophthalmology. – 2020. – Vol. 32, № 1. – Р. 186-189. (in Russ.)

13. Kinoshita T, Onoda Y, Maeno T. Long-term surgical outcomes of the inverted internal limiting membrane flap technique in highly myopic macular hole retinal detachment. Graefe Archive for Clinical and Experimental Ophthalmology. – 2017. – Vol. 255, № 6. – P. 1101–1106.

14. Ghoraba Н, Mansour Н, Abdelhafez Elsayed МА. Risk factors for recurrent myopic macular hole retinal detachment after silicone oil removal in patients with open flat macular hole. Ophthalmologica. – 2021. – Vol. 244, № 2. – Р. 118–126.

15. Deobhakta A, Rosen R. Retinal tamponades: current uses and future technologies. Current Ophthalmology Reports. – 2020. – Vol. 8, № 3. – P. 144–151.

16. Kleymenov A.Yu., Kazaykin V.N., Lizunov A.V. Remote functional and anatomical results of idiopathic macular hole surgery performed without postsurgical vitreous cavity tamponade. Russian Ophthalmological Journal. – 2022. – Vol. 15, № 2. – Р. 30-36. (In Russ.)

17. Patent № 2803882 C1 Rossiiskaya Federatsiya, MPK A61F 9/007 Method of surgical treatment of rhegmatogenic retinal detach complicated by percentral macular rupture: № 2023102545: zayavl. 03.02.2023: opubl. 21.09.2023 Byul. № 27 / Faizrakhmanov R.R., Vaganova E.E.; zayavitel’ Faizrakhmanov R.R., Vaganova E.E. (In Russ.)

18. Spaide R.F. “Dissociated optic nerve fiber layer appearance” after internal limiting membrane removal is inner retinal dimpling. Retina. – 2012. – Vol. 32, № 9. – Р. 1719-1726.

For citation

Vaganova Е.Е., Кonovalova К.I. Remote functional results patients with macular hole and rhegmatogenous retinal detachment surgical treatment with different volumes of preservation of the internal limiting membrane according to microperimetry data. Bulletin of Pirogov National Medical & Surgical Center. 2024;19(4,supplement):129-132. (In Russ.) https://doi.org/10.25881/20728255_2024_19_4_S1_129