Despite the high level of development of modern macular surgery, recurrent macular holes remain a rather serious problem for vitreoretinal surgeons. Recurrent macular holes can be of two types: macular holes that have not closed after primary surgery, and macular holes that have reopened after a successful initial surgery. In foreign literature they are called persistent and recurrent macular holes. This article presents a review of modern scientific literature on epidemiology, causes of development and surgical treatment of recurrent macular holes. This review provides information on the rationality and effectiveness of modern surgical approaches to the treatment of this condition. The most effective methods for treating large macular holes, which are one of the main causes of failure to close a defect during the first surgery or the development of a recurrence of this condition sometime after the first surgery, are covered. Based on the literature data, we can say that the main methods of choice in surgery for recurrent macular holes today are the use of platelet-rich plasma and various modifications of the inverted internal limiting membrane flap technique, transplantation of the autologous internal limiting membrane, including the displaced internal limiting membrane flap technique patented in the Russian Federation.
Vitreoretinal surgery is an actively developing area of modern ophthalmic surgery. Intravitreal interventions in the central retina with large full-thickness macular holes deserve special attention. This article provides an overview of the scientific literature published in journals recommended by the Higher Attestation Commission, also presented in the scientific databases Scopus, PubMed, dedicated to modern techniques to the surgical treatment of large full-thickness macular holes. The main methods for closing defects in the macular area today are the use of various modifications of the inverted internal limiting membrane flap technique and the application of autologous platelet rich plasma in a macular hole. These techniques provide high anatomical and functional outcomes. Modifications of the inverted internal limiting membrane flap technique demonstrated effectiveness in such complex clinical situations as recurrent macular holes, concomitant high myopia, retinal detachment. Over the past 10 years, data on the use of autologous platelet-rich plasma for this group of patients appeared in the scientific literature. More accurate surgical procedures are required for the use of this technique compared with the standard methods, but this technique is applicable in all patients, does not require additional manipulations (blood sampling and centrifugation), additional equipment. Vitreoretinal interventions with the use of platelet-rich plasma are characterized by relative simplicity and ease of carrying out surgical procedures. However, it is important to consider the possibility of pseudouveitis development, the need for additional equipment. Since both of these methods demonstrate good anatomical results, the problem of choosing a technique in a particular clinical case remains. It was clear that the method of surgical intervention should be chosen, taking into account possible disadvantages and limitations to the method, as well as the skills of an ophthalmic surgeon. The lack of a unified approach to macular hole surgery encourages researchers to improve surgical techniques, develop and implement new modifications of surgical approaches.
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