Surgical Treatment of Primary Penetrating Macular Retinal Tears Using an “Effective” Fragment of the Internal Limiting Membrane

The purpose: to develop a technology for the surgical treatment of macular retinal tears using an “effective” fragment of the ILM with an optimal shape, size, and localization, and evaluate its anatomical and functional efficiency.

Methods. There were 10 patients (8 women, 2 men) with primary through macular holes of large diameter (more than 400 microns) under observation. The age were from 55 to 64 years old. The duration of macular tear existence ranged from 4 to 11 months. Patients underwent standard research methods, SOCT and microperimetry. To retain the point of visual fixation and eliminate the risk of retinal trauma, all patients underwent surgical treatment of macular tear using the developed method for the surgical treatment of macular retinal tears using an “effective” ILM fragment of the required shape, size and localization. Before the operation, individual parameters for each patient and zones of localization of the “effective” ILM fragment were calculated, which consisted of two parts: the upper inverted fragment and the intact foveolar fragment of the inner limiting membrane. The follow-up period was 1, 3, 6 months and 1 year after the operation.

Results. Surgical treatment of MR in all patients was carried out completely without complications. In all cases, it was possible to preserve the zone of the foveolar intact fragment of the ILM and form the upper inverted fragment of the ILM, which directly covers the macular hole. Improvement of the anatomical state of the retina in the foveal area was achieved according to SOCT data. After 1 month, all patients had a “defect” (hyporeflective area) in the ellipsoid zone of photoreceptors with a width of 112 to 357 μm. The outer boundary membrane was clearly visible and had a linear profile. A complete resorption of edema along the edges of the tear happened. An intact foveolar fragment of the ILM was visualized on the surface of the retina, blocking the macular hole. After 3 months, in 3 patients, the defect of the outer layers of the retina completely disappeared. After 3, 6 and 12 months, the state of the retina of these patients was unchanged. All patients showed improvement in functional outcomes after surgical treatment. There was an increase in BCVA at all terms.

Conclusion. The developed technology of surgical treatment using an “effective” ILM fragment is modern and safe in the treatment of penetrating primary macular retinal tears, and reduces the risk of intra- and postoperative complications.

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