Variants of the reparative activity of the foveolar zone in the closure of the macular hole by autoplasty in internal limiting membrane

2021 ◽  
pp. 126-131
Author(s):  
M.M. Shishkin ◽  
◽  
O.А. Pavlovskiy ◽  
E.A. Larina ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
Morphological Changes ◽  
Central Zone ◽  
Internal Limiting Membrane ◽  
Original Method ◽  
Internal Boundary ◽  
Ophthalmological Examination ◽  
Functional Parameters ◽  
Group 2

Purpose. Propose a new technique of operation macular discontinuity, which is based on the preservation of the internal limiting membrane (ILM), and to assess the dynamics of retinal morphological and functional parameters for different embodiments of wound healing. Material and methods. The results of surgical treatment of 240 patients (240 eyes) with the diagnosis of macular hole were analyzed. Group 1 (120 eyes) – patients who underwent surgical treatment according to the standard method. Group 2 (120 eyes) – patients who were operated on using the original method with partial exfoliation of ILM in the Central zone. All patients underwent ophthalmological examination before and after surgery, including visometry, biomicroscopy, ophthalmoscopy and OCT. Results. Preoperative functional parameters of the retina in patients of both groups were comparable. During the study, two types of closure of macular tears were identified. When studying the morphological changes in the «pseudocyst» type of macular rupture repair in patients of both groups, a more pronounced resistance of the neuroretinal tissue is observed in patients of the 1st group. In the 2nd group, a more pronounced dynamics of a decrease in the morphological parameters of the hyporeflexive defect was revealed throughout the entire observation period. With the complete closure of the macular gap, a higher rate of regression of edema of neuroepithelial tissue is observed in patients of the 2nd group. Conclusion. 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. Key words: macular rupture, peeling, internal boundary membrane, optical coherence tomography.

The closure of the macular holes with the use of autoplasty ILM: a comparative analysis of functional and morphological parameters

2021 ◽  
pp. 122-126
Author(s):  
O.А. Pavlovskiy ◽  
◽  
М.М. Shishkin ◽  
R.R. Fayzrakhmanov ◽  
E.A. Larina ◽  
...  
Keyword(s):  
Macular Hole ◽  
Statistical Processing ◽  
Internal Limiting Membrane ◽  
Original Method ◽  
Ophthalmological Examination ◽  
Macular Holes ◽  
Nasal Side ◽  
Before And After ◽  
Group 2 ◽  
Group 1

Actual. Peeling the internal limiting membrane when closing the macular tear is a fundamental procedure. However, recently, additional microtraumatization of the layers of neuroretinal tissue during peeling and changes in morphofunctional parameters have been proven. Purpose. The aim of this study was to propose a technique with autoplasty of the ILM and preservation of the papillomacular bundle in the area and to assess the dynamics of morphofunctional parameters after surgery for a macular hole. Materials and methods. Morphofunctional data of 200 patients (100 eyes) were studied.) Patients of group 1 (100 eyes) were operated on using the introverted flap technique Patients of group 2 (100 eyes) were operated on using the original method with the preservation of ILM in the foveolar zone. All patients underwent a standard ophthalmological examination before and after surgery. The assessment of morphometric data was carried out on the basis of the ACT-study. Statistical processing of the results was carried out using the IBM SPSS Statistics 23 program. Results. According to the results of surgical treatment on the 7th day and on the 30th day after the operation, higher indicators of functional parameters of the retina were revealed in patients of the 2nd group. In comparison with the data before surgery, BCVA increased 2.55 times in group 1, and 4.46 times in group 2. There was a significant decrease in MH height-n in patients of group 1 in comparison with data before surgery and group 2 in comparison with data before surgery by 1.68 and 2.12 times, respectively. This is due to the lack of additional microtraumatization of neuroretinal tissue (no peeling) on the nasal side of the macular hole. Keyword: macular hole, ILM peeling, vitrectomy.

Dynamics of changes in microperimeric parameters of retina in various methods of closing macular breaks based on autoplasty of internal limiting membrane

2021 ◽  
pp. 132-136
Author(s):  
M.M. Shishkin ◽  
◽  
O.А. Pavlovskiy ◽  
E.A. Larina ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vitreoretinal Surgery ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Light Sensitivity ◽  
Original Method ◽  
Retinal Layers ◽  
Macular Holes ◽  
Group 2 ◽  
A New Technique

Currently, vitreoretinal surgery is one of the most effective methods of treating macular holes that can improve the quality of vision, and the most common method of such treatment is vitrectomy with the removal of the internal border membrane around the rupture and the use of autoplasty of the internal border membrane. Microperimetric retinal testing measures the sensitivity of the retina at certain points on a larger surface and detects relative or absolute microscotomas, which allows you to objectively assess the state of the central part of the retina. At the same time, the search for ways to reduce the risk of macular surgery complications and improve functional results continues. Purpose. To propose a new technique for macular tear surgery, which is based on autoplasty of the VPM and reduction of microtraumatization of the retinal layers. Material and methods. The results of surgical treatment of 240 patients (240 eyes) with a diagnosis of macular holes were analyzed. All patients underwent surgical treatment for MH. Depending on the method of closing the macular hole, the patients were divided into two groups: group 1 – patients who underwent surgical treatment using the standard introverted flap technique. Group 2 – patients who were operated on according to the original method with partial peeling of ILM in the macular area. All parameters in the preoperative period were statistically comparable. Results. The most significant are the results obtained on the 30th day after surgical treatment. According to the results of surgical treatment, there was a significant excess of light sensitivity parameters in the nasal part of the pattern used: the upper-nasal and lower-nasal quadrants, where peeling was not performed. Conclusion. During this technique, there is a preservation ILM, which reduces the risk of intraoperative damage to the retinal layers. A higher functional result was obtained. Key words: microperimetry, macular rupture, ILM peeling.

scholarly journals Update on surgical management of complex macular holes: a review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohd-Asyraaf Abdul-Kadir ◽  
Lik Thai Lim
Keyword(s):  
Surgical Treatment ◽  
Morphological Changes ◽  
Internal Limiting Membrane ◽  
Small Subset ◽  
Human Amniotic Membrane ◽  
Surgical Interventions ◽  
Long Term Study ◽  
Macular Holes ◽  
Surgical Options ◽  
Pars Plana

AbstractModern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.

scholarly journals Hole edge morphology by intraoperative OCT predicts restoration of the retina microstructure in macular hole surgery

2019 ◽  
Author(s):  
Jiwei Tao ◽  
Huan Chen ◽  
Lin Zhu ◽  
Deming Pan ◽  
Jia Fang ◽  
...  
Keyword(s):  
Macular Hole ◽  
Morphological Changes ◽  
Internal Limiting Membrane ◽  
Hole Size ◽  
Negative Group ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Hole Edge ◽  
Intraoperative Oct ◽  
Large Macular Hole

Abstract Objectives: To investigate the association between iOCT feature inmacular hole surgery and the restoration of the retina microstructure and visualoutcomes. M ethods: Fifty-three eyes of 53 patients with macular hole were recruited in this retrospective study. All eyes were assessed with intraoperative OCT after internal limiting membrane peeling. We divided the patients in to three groups:fovel flap group, hole-door group, and negative group，according to morphological changes on the edge of hole using iOCT after ILM peeling. We compared the anatomical and functional surgical outcomes between these groups. ResultsThe negative group had significantly poorer BCVA and restoration of the ELM than other two groups(P=0.002,0.012) at 6 months postoperatively. In the hole size ≤400um group，There were no statistical difference of ELM restoration and BCVA postoperatively between the groups. While in hole size > 400um group, The hole-door group and fovea flap group had significantly better final visual acuity and restoration of ELM than the negative group(P=0.013,P=0.005) Conclusion: This study describes a novel intraoperative sign using iOCT. This sign is a useful predictor of postoperative in restoration of the retina microstructure and visual outcomes of the macular hole，especially in large macular hole.

scholarly journals Surgical Treatment of Previously Unclosed Macular Holes

2020 ◽  
Vol 17 (3) ◽  
pp. 368-374
Author(s):  
R. R. Faizrakhmanov ◽  
E. A. Larina ◽  
O. A. Pavlovskii
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Macular Hole ◽  
Free Flap ◽  
Inverse Correlation ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Morphological Parameters ◽  
Photoreceptor Layer ◽  
Macular Holes

Macular holes are the most often pathology leading to reduced vision among persons after 60 years. The macular hole is the acquired disease which is a defect of a foveola part of retina on all thickness from an internal limiting membrane to an external segment of a photoreceptor layer. The standard method of treatment is surgery method: a microinvasive vitrectomy with membrane peeling in macular area. There is a number of the techniques increasing efficiency of operative intervention. Even in case of successful surgical intervention macular holes are not always closed.The purpose: development and assessment of morphological parameters of the central retina with a new surgical method of closing earlier operated macula hole using a free flap.Material and methods. 40 patients (40 eyes, 28 women and 12 men) had participated in this study. All patients were operated about macular hole with negative anatomic result. By technology which were used earlier, patients were divided into 3 studied groups (with PRP mass using, with introverted flap using, with mechanical matching of edges of a hole). The main method of research was the optical coherent tomography. All patients were operated by an original technique. It’s purpose was a closing of earlier operated rigid macular hole using a free flap.Results. The defect of a photoreceptor component was closed with an additional expansion of earlier created macular rexis in patients of the 1st and 3rd groups at reoperation. The earlier created flap of an internal limiting membrane was used in patients of the 2nd group. In the analysis of dependence of change of visual acuity from morphological parameters of a macular hole after primary surgical treatment the inverse correlation relation from diameter of a macular hole on small and big radiuses is revealed. The highest visual acuity after a reoperation was reached at patients of the second group.Conclusions. It is necessary to consider the technique which was used earlier, diameter of a macular hole on small and big radiuses, postoperative edema in a parafovea zone for planning the surgical treatment and a forecast of functional results. 

scholarly journals Dosing of the Degree of Anterior Transposition of Lower Oblique Muscle in the Surgical Treatment of Its Secondary Hyperfunction

2018 ◽  
Vol 15 (2S) ◽  
pp. 106-112
Author(s):  
A. V. Tereshhenko ◽  
I. G. Trifanenkova ◽  
A. A. Vydrina
Keyword(s):  
Surgical Treatment ◽  
Oblique Muscle ◽  
Ophthalmological Examination ◽  
Vertical Angle ◽  
Primary Position ◽  
Vertical Deviation ◽  
Anterior Transposition ◽  
Duration Of Surgery ◽  
Group 2 ◽  
Group 1

The purposeto evaluate the effectiveness of dosing procedures for the degree of anterior transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction of varying severity using modern methods of ophthalmological examination.Patients and methods. Between January 2013 and June 2017, 31 children (31 eyes) aged 3 to 17 years with vertical strabismus due to unilateral insufficiency of the superior oblique muscle were monitored. Depending on the magnitude of the vertical deviation in the adduction on the paretic eye measured in degrees by the Hirschberg method in the head rotation position, all patients were divided into two groups: group 1 — 12 children (12 eyes) (no more than 7° according to Hirschberg); group 2 — 19 patients (19 eyes) (more than 7° according to Hirschberg). Surgical treatment of hypertrophy was performed in all patients in both groups. Weakened the lower oblique muscle by its dosed front transposition. The degree of anterior transposition of the lower oblique muscle depended on the magnitude of the angle of vertical deviation.Results. The surgical intervention on the lower oblique muscle was performed in all patients in full. Hypertrophy in the primary position of the gaze in group 1 was completely eliminated in 11 eyes (91.7%), in group 2 — in 17 eyes (89.5%). The residual vertical angle, equal to 3 ° according to Hirschberg, in group 1 was detected in 1 eye (8.3%), in group 2 — in the 2 eyes (10.5%). Hypertrophy in adduction in group 1 was completely eliminated in 10 eyes (83.3%), in group 2 — in 17 eyes (89.5%). The residual vertical angle of 3° in Hirschberg’s group 1 was detected in 2 eyes (16.7%), in group 2 — in 2 eyes (10.5%).The conclusion. Application of the technology of dosed front transposition of the lower oblique muscle in the surgical treatment of its secondary hyperfunction will significantly improve the effectiveness and safety of treatment and reduce the risk of complications, shorten the duration of surgery and anesthesia in child. The developed method of dosing the degree of anterior transposition allows to perform this operation monolaterally, without fear of developing secondary hyperfunction of the lower oblique muscle in the pair eye. 

scholarly journals A retrospective analysis of the results of surgical treatment of large macular holes

2018 ◽  
Vol 99 (2) ◽  
pp. 341-344
Author(s):  
A N Samoylov ◽  
G A Fazleeva ◽  
T R Khaybrakhmanov ◽  
P A Samoylova ◽  
M A Fazleeva
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Retrospective Analysis ◽  
Ophthalmological Examination ◽  
Modified Technique ◽  
Complete Closure ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
Group 2 ◽  
Group 1

Aim. A retrospective analysis of the results of surgical treatment of large idiopathic macular holes depending on the technique of surgical intervention. Methods. The results of surgical treatment of 60 patients (60 eyes) with idiopathic macular holes with a diameter of more than 800 μm were studied in the Republican clinical ophthalmology hospital of Kazan. The average age of the patients was 66.2±5.37 (61-74) years. The patients underwent complex ophthalmological examination before the surgery and 10 days and 1 month after the surgery, including visometry, tonometry and optical coherence tomography. Patients were divided into two groups (30 subjects each), comparable in clinical and epidemiological parameters: group 1 - standard surgical tactics, group 2 - surgical treatment according to the method proposed by professor A.N. Samoylov. Visual acuity with correction before surgery in group 1 was 0.11±0.05, in group 2 - 0.12±0.06. Results. Ten days after the surgery, group 1 had anatomical closure in 23 (76.7%) patients, anatomical result was not achieved in 7 (23.3%) patients. In group 2, complete closure of the rupture was achieved in 27 (90.0%) patients, incomplete - in 3 (10.0%) patients. In 1 month in group 1, complete closure of the macular rupture was observed in 22 (73.3%) patients, in 8 (26.7%) patients the result was not achieved. In group 2, complete closure of the rupture was determined in 28 (93.3%) patients, incomplete closure - in 2 (6.7%) patients. Visual acuity 1 month after the surgery in group 1 was 0.15±0.08, and in group 2 - 0.32±0.11 (p <0.05). Conclusion. Surgical treatment of large idiopathic macular holes according to the modified technique of the inverted internal limiting membrane flap proposed by professor A.N. Samoylov, provides better anatomical and functional results in comparison with the standard technique (p <0.05).

Contractility of inverted internal limiting membrane flap after vitrectomy for macular hole

2021 ◽  
Author(s):  
Akira Hirata ◽  
Keiko Mine ◽  
Ken Hayashi
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Morphological Changes ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Rank Test ◽  
Flap Technique ◽  
Signed Rank ◽  
Good Visual Outcome ◽  
Signed Rank Test

Abstract We investigated the postoperative visual outcomes and morphological changes of the internal limiting membrane (ILM) flap, in patients who underwent the inverted ILM flap technique for macular hole (MH). Between August 2018 and February 2020, 22 eyes of 22 patients with idiopathic or myopic MH who underwent vitrectomy with ILM flap were included in this study and followed-up for more than six months. Postoperative MH status, comparison of best-corrected visual acuity (BCVA) before and six months after surgery, changes in the ILM flap area at one and six months postoperatively, and the factors related to changes in ILM flap size, were analyzed. MH closure was achieved in all of the patients. The BCVA at six months postoperatively (0.18 ± 0.15) was significantly better than the preoperative BCVA of 0.63 ± 0.37 (P = 0.000005, paired t-test). The area of the ILM flap decreased significantly from 3.25 ± 1.27 mm2 at one month to 3.13 ± 1.23 mm2 at six months (P = 0.024, Wilcoxon signed-rank test). Two eyes showed an ILM flap contraction of more than 20%, and one eye required re-operation due to an increase in metamorphopsia and decreased visual acuity. Among age, sex, ILM flap area at one month, preoperative BCVA, and axial length, ILM flap contraction was correlated with patient age and ILM flap area. Although vitrectomy with the inverted ILM flap technique confers a good visual outcome, the ILM flap may contract in younger patients.

The use of autologous conditioned plasma (ACP) in the surgical treatment of full-thikness macular holes

2021 ◽  
pp. 102-105
Author(s):  
I.V. Laskova ◽  
◽  
A.A. Kravchenko ◽  
D.I. Uskov ◽  
E.V. Lopina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
High Efficiency ◽  
Silicone Oil ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Ophthalmic Surgery ◽  
Macular Holes ◽  
Number Of Patients

Increasingly, the use of autologous conditioned plasma in ophthalmic surgery in recent years has been given more preference than other blood products with similar effects. Surgical treatment of full-thikness macular hole is no exception. Domestic and foreign studies of recent years show that the use of ACP as an adhesive component in the treatment of this pathology is considered the most acceptable. However, in addition to the effective "gluing" of the macular hole, the convergence of its edges plays an important role in the postoperative anatomy of the foveolar zone. Objective: to study the effectiveness of the use of autologous conditioned plasma in the surgical treatment of full-thikness macular hole. Materials and methods of research. Patients who underwent surgery for a full-thikness macular hole with a diameter of more than 400 microns were prospectively observed. The study included 51 patients. The follow-up period ranged from 2 months to 1 year. All patients in the preoperative and postoperative periods underwent a comprehensive ophthalmological examination. Surgical technique: after a standard three-port vitrectomy (25Ga), the posterior hyaloid membrane was removed, and the ILM was peeled. With the help of a saline solution, a circular separation of the bonds between the edges of the gap and the pigment epithelium was achieved. After the subretinal fluid was removed and the induced local central retinal detachment was attached, the tear area was irrigated by ACP. After that, the air was replaced with silicone oil, which was removed after 1.5 months. Nodal sutures were applied to the sclerotomy (vicryl 8-0). Results. In 49 operated patients, anatomical restoration of the foveolar zone was achieved, which accounted for 96% of the total number of patients. Visual functions were evaluated after 1.5 months (after removal of silicone oil). Corrected visual acuity in 96% of patients ranged from 0.2 to 0.5. Conclusion. The high efficiency of the use of autologous conditioned plasma in the treatment of full-thikness macular holes allows us to achieve high anatomical and functional results. Key words: macular rupture, autologous conditioned plasma, silicone tamponade.

The analysis of the results of surgical treatment of macular holes of varying degrees of complexity

2021 ◽  
pp. 117-121
Author(s):  
Y.I. Malakhova ◽  
◽  
E.M. Molokotin ◽  
◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Key Words ◽  
Macular Hole ◽  
Eye Diseases ◽  
Functional Parameters ◽  
Silicon Oil ◽  
Ocular Pathology ◽  
Macular Holes ◽  
Key Words Macular Hole

Purpose. To provide an analysis of the results of surgical treatment of macular holes, reflecting our own experience of vitreoretinal operations for this pathology of the macular interface. Material and methods. The work was carried out in a private ophthalmological clinic "EyeDoctor" in Almaty, Kazakhstan. The patients were divided into 3 groups, depending on the stage of macular holes and concomitant eye diseases. Results. 1. The macular hole 2-3 stage it is enough to carry out vitrectomy with careful removal of the ILM and PRP technology (the defect is up to 400 microns). 2. The macular hole 4 stage – removal the ILM with PRP technology with obligatory tamponade with silicon oil. Conclusion. To predict the results, it is necessary to take into account the stage of macular hole, its morphological and functional parameters, the duration of the process and the presence of concomitant ocular pathology. Key words: macular hole, J.D. Gass classification, vitrectomy, PRP method.

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