Comparison of Early Treatment Outcomes for Large Macular Hole Using Various Surgical Techniques

Macular hole (MH) is one of the most common pathologies of the macular area of the retina which leads to a significant decrease in visual acuity. The article presents early comparative morphofunctional results of surgical treatment of 60 patients (22 men and 38 women) with MH of the III–IV stages according to Gass and the minimum diameter (MinD) MH 404–696 microns. All patients included in the study had pseudophakia and have not previously undergone endovitreal interventions. Patients with MH with a diameter of 404–696 μm were randomized and divided into 3 equal groups: after three-port 25G pars plana posterior vitrectomy the patients of the first group underwent peeling of the inner limited membrane (ILM) with the convergence of the edges of MH and vitreous cavity tamponade with 16 % gas-air mixture of perfluoropropane (C₂F₆). In the area of the macular defect, patients of the second group underwent application of autologous conditioned plasma (ACP) in the PFСs environment and the convergence of the edges of MH. In patients of the third group, MH was closed using the technique of an inverted ILM flap. In patients of groups 2 and 3 the operation was completed by tamponade of the vitreous cavity with sterile air. Standard and special research methods, such as optical coherence tomography of the macular zone, were performed before surgery, 5 days and 1 month after surgery in all patients from groups 2 and 3. Patients from group 1 were examined before surgery and 1 month after surgical treatment, due to the long-lasting gas-air mixture in the vitreous cavity. Restoration of the correct structure of the fovea with the formation of U- and V-shaped profile during OCT after 1 month was noted in all cases. The data obtained demonstrate the peculiarities of using the inverted ILM flap and ACP methods in comparison with the traditional method of MH closure with a gas-air mixture.

1. Duker J.S., Kaiser P.K., Binder S., de Smet M.D., Gaudric A., Reichel E., Sadda S.R., Sebag J., Spaide R.F., Stalmans P. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611–2619. DOI:10.1016/j.ophtha.2013.07.042

2. Alpatov S.A. Classification of idiopathic macular retinal tears Siberian Medical Journal = Sibirskiy meditsinskiy zhurnal. 2004;6(47):56–59 (In Russ.).

3. Shkvorchenko D.O., Khoroshilova-Maslova I.P., Andreeva L.D. Surgical treatment of idiopathic tears with removal of the inner bordering membrane of the retina Moscow; 2002:338–346 (In Russ.).

4. Gupta D. Face-down posturing after macular hole surgery. A review. Retina. 2009;29(4):430–443. DOI: 10.1097/IAE.0b013e3181a0bd01

5. Jančo L., Vida R., Bartoš M. Surgical treatment of the idiopatic macular hole — our experience. Cesk Slov Oftalmol. 2013;69(3):102–105.

6. Belyi Yu.A., Tereshchenko A.V., Shkvorchenko D.O. Surgical treatment of large idiopathic macular tears. Practical medicine = Prakticheskaya meditsina. 2015;2:119–123 (In Russ.).

7. Samoylov A.N., Fazleeva G.A., Khaybrakhmanov T.R. A retrospective analysis of the large macular holes surgical treatment. Kazan Medical Journal = Kazanskiy medicinskiy zhurnal. 2018;99(2):341–344 (In Russ.). DOI: 10.17816/KMJ2018-341

8. Wong R. Novel surgical technique for closure of large full-thickness macular holes. Retina. 2013;33:1977–1979. DOI: 10.1097/IAE.0b013e318297a21a

9. Felfeli T., Mandelcorn E.D. Macular hole hydrodissection: Surgical technique for the treatment of persistent, chronic, and large macular holes. Retina. 2019;39:743–752. DOI: 10.1097/IAE.0000000000002013

10. Charles S., Randolph J.C., Neekhra A., Salisbury C.D., Littlejohn N., Calzada J.I. Arcuate retinotomy for the repair of large macular holes. Ophthalmic Surg Lasers Imaging Retina. 2013;44:69–72. DOI: 10.3928/23258160-20121221-15

11. Yepez J.B., Murati F.A., De Yepez J., Petitto M., Arevalo J.F. Anterior lens capsule in the management of chronic full-thickness macular hole. Retin Cases Brief Rep. 2018;12:286–290. DOI: 10.1097/ICB.0000000000000513

12. Michalewska Z., Michalewski J., Adelman R., Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117(10):2018–2025. DOI: 10.1016/j.ophtha.2010.02.011

13. Petrachkov D.V., Zamytskii P.A., Zolotarev A.V. A method of surgical treatment of penetrating macular ruptures Patent RU 2667622 C2, 21.09.2018 (In Russ.).

14. Kazaikin V.N.., Novoselova T.N. A method for the surgical treatment of large idiopathic macular ruptures using the “inverted flap of the inner bordering membrane” technique». Рatent RU 2617528, 22 04 2017 (In Russ.).

15. Fayzrakhmanov R.R., Pavlovskiy O.A., Larina E.A. The method of closing macular holes with partial preservation of the internal limiting membrane. Russian annals of ophthalmology = Vestnik oftal’mologii. 2020;1:73–79 (In Russ.). DOI: 10.17116/oftalma202013601173

16. Arsyutov D.G., Andreev A.N. Surgical approach for treating large and giant macular rupture. Point of view. East-West = Tochka zrenija. Vostok — Zapad. 2016;2:97–98 (In Russ.).

17. Zakharov V.D., Shkvorchenko D.O., Krupina E.A. The efficacy of platelet-rich blood plasma in the surgery of large macular ruptures. Practical medicine = Prakticheskaya meditsina. 2016;9:118–121 (In Russ.).

18. Lacci K.M., Dardik A. Platelet-rich plasma: Support for its use in wound healing. Yale J Biol Med. 2010;83:1–9.

19. Arsyutov D.G. The use of a new type of platelet-rich plasma — autologous conditioned plasma (ACP) — in surgery of rhegmatogenous retinal detachment with large and multiple tears, detachment from the dentate line. Modern technologies in ophthalmology = Sovremennye tekhnologii v oftal’mologii. 2019;1:22–25 (In Russ.). DOI: 10.25276/2312-4911-2019-1-22-25

20. Bikbov M.M., Zainullin R.M., Gil'manshin T.R., Zinnatullin A.A., Gizzatov A.V. The results of large macular hole surgery using autologous conditioned plasma. Point of view. East-West = Tochka zrenija. Vostok — Zapad. 2020;2:33–35 (In Russ.). DOI: 10.25276/2410-1257-2020-2-33-35

21. Abdelkader A.M.E., El-Metwaly M.N.R., Khalaf M.A., El Bendary A.M., El-Kannishy A.M.H. Vitrectomy for idiopathic macular hole: outcomes and complications. Benha Medical Journal. 2015;32(2):107. DOI: 10.4103/1110-208X.180323

22. Babu N., Kohli P., Ramachandran N.O., Adenuga O.O., Ahuja A., Ramasamy K. Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study. Indian J Ophthalmol. 2020;68(5):880–884. DOI: 10.4103/ijo.IJO_1357_19