The method of closure of macular holes with a partial peeling of the internal limiting membtane: comparative analisis
Fayzrahmanov R.R., Pavlovskiy O.А., Larina E.A.
Federal state budgetary institution "National Medical and Surgical Center named after N.I. Pirogov" of the Ministry of Healthcare of the Russian Federation
Brief summary
Recently, more and more data are available on mechanical and subclinical traumatic changes in the layer of retinal nerve fibers during surgery for macular holes, namely during peeling (removal of the internal limiting membrane (ILM)).
Purpose of the study was to propose a new technique for surgery for macular hole, which is based on the preservation of ILM and to assess the dynamics of the functional parameters of the retina.
Materials and methods: The results of surgical treatment of 16 patients (16 eyes) with a diagnosis of macular hole were analyzed.
Group 1 (8 eyes) - patients who underwent surgical treatment according to the standard method: after vitrectomy, ILM pilling was performed.
Group 2 (8 eyes) - patients who were operated on according to the original method with partial peeling of ILM in the central zone. Before and after the operation, all patients underwent standard ophthalmologic examination, including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT), Rtvue, Optovue, USA.) MAIA (Macular Integrity Assessment) microperimetric study (CenterVue, USA).
Results. The preoperative functional parameters of the retina in patients of both groups were comparable. After surgery, the average sensitivity of the retina of the macular region was significantly lower in patients of group II. Absolutely paracentral microscotomas (that is, outside the MR region were found, in group I - 5/8 eyes, in group II - 1/8. Relative microscotomas were detected in the eyes of group II patients 2.9 times more often than in patients of group I. When analyzing the microperimetric parameters by zones, an increase in light sensitivity in the upper nasal and lower nasal sectors of the macular region over a large and medium radius was revealed.
Discussion. Based on this study, we can conclude that during this technique, the ILM is preserved, which reduces the risk of intraoperative damage to the retinal layers.
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