Assessment of the degree of restoration of the retinal structure and chorioretinal blood flow after surgical treatment of large-diameter macular holes

Abstract

The aim: to evaluate the restoration features of the structural relationships of the retina and chorioretinal blood fl ow after surgical treatment of large-diameter macular hole (MH) using a modifi ed technology.Material and methods. A prospective study of 14 patients (14 eyes), 13 women and 1 man, with medium-and large-diameter MH was conducted. The mean age of the patients was 67.7 ± 5.38 (55–80) years. The study included patients with endto-end MH of the 3rd–4th stage according to the classifi cation of J. Gass. All patients underwent surgical treatment of macular rupture according to the proposed method of inverted fl ap of the internal limiting membrane (ILM) and fi lling it into a “pocket” formed between the retina and the ILM.Optical coherence tomography (OCT) was performed along with traditional research methods. The obtained images were used to measure manually the parameters of retinal MH, the thickness of the choroid in the projection of the rupture and the fovea zone before the operation and 1, 3 and 6 months after the operation. In the angio-mode, the foveal avascular zone (FAZ) was evaluated, as well as the density of capillaries of the superfi cial and deep retinal plexus in four quadrants, with the exception of the central zone.Results. In all patients, it was possible to achieve MH blocking. Visual acuity in the eyes with MH varied from 0.02 to 0.3, while in the comparison group, the best corrected visual acuity was from 0.3 to 1.0 (p = 0.002). An increase in the diameter of large choroidal vessels, as well as a pronounced decrease in the diameter of the posterior short ciliary artery, attracted attention. However, despite the improvement in visual acuity, patients retained a signifi cant expansion of the FAZ, which by 6 months exceeded the FAZ area of the paired eye by 25.8 % (p = 0.01).Conclusion. The results obtained indicate that the achievement of an anatomicalreconstructive effect and even a moderate improvement in visual acuity during surgical treatment of macular holes by the modifi ed inverted flap technology of the internal limiting membrane does not determine the restoration of retinal perfusion in full.

Tekhnologiya mikrohirurgicheskoj rekonstrukcii fovea pri makulyarnyh razryvah

“…Долгое время золотым стандартом лечения сквозного макулярного разрыва считали витрэктомию, проведение пиллинга внутренней пограничной мембраны (ВПМ) с последующей тампонадой воздухом/газо-воздушной смесью [8]. С целью дополнительного повышения эффективности предложены модификации хирургического подхода в лечении макулярных разрывов: механическое сближение краев разрыва, проведение пилинга ВПМ с последующим закрытием разрыва инвертированным лоскутом ВПМ, амниотической мембраной, трансплантация передней капсулы хрусталика, сохранение ВПМ [9][10][11][12].…”