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.

Method of surgical treatment of small and medium diameter macular holes with the foveal-sparing internal limiting membrane peeling

2021 ◽  
pp. 213-216
Author(s):  
A.A. Shpak ◽  
◽  
A.I. Kolesnik ◽  
F.A. Avakyan ◽  
V.A. Pismenskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Developed Countries ◽  
Clear Understanding ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Air Tamponade ◽  
Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.

Differentiated Approach to Strategies of Surgical Treatment of Idiopathic Macular Holes

The Eye ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 12-16
Author(s):  
R. Z. Shamratov ◽  
L. Sh. Ramazanova ◽  
O. A. Napylova
Keyword(s):  
Surgical Treatment ◽  
Vitreoretinal Surgery ◽  
Internal Limiting Membrane ◽  
Pathological Process ◽  
Hole Diameter ◽  
Corrected Visual Acuity ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
Anatomical Outcome ◽  
Clinical Cases

Background. 25G or 27G three-port vitrectomy, followed by staining and removal of the internal limiting membrane with vitreous cavity air or gas tamponade, is one of the main modern vitreoretinal surgery principles for primary macular holes. However, not all patients manage to obtain a functional outcome when the anatomical outcome is achieved. Purpose. To  present clinical cases of surgical treatment of idiopathic macular holes (IMH) exhibiting a differentiated approach.Matherials and methods. This article analyzes clinical cases of four patients with primary idiopathic macular holes, differing in terms of development, hole diameter and the presence of comorbidities. Results. The results of surgical treatment were evaluated 14 days and 1 month after surgery. In all clinical cases, surgical treatment resulted in a positive anatomical outcome by blocking a retinal defect. Best corrected visual acuity increased, on average, from 0.08 ± 0.05 to 0.4 ± 0.05.Conclusion. The analysis of the presented clinical cases clearly demonstrates the need for a timely and differentiated approach to the treatment of patients with IMH, that considers etiology of the pathological process, period of its existence as well as concomitant and general somatic pathologies.

Clinical and functional results of closing macular holes with the foveal-sparing internal limiting membrane peeling

2021 ◽  
pp. 34-37
Author(s):  
A.I. Kolesnik ◽  
◽  
S.V. Kolesnik ◽  
F.A. Avakyan ◽  
A.A. Shpak ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Developed Countries ◽  
Clear Understanding ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Air Tamponade ◽  
Anatomical Success ◽  
Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success. Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. Thus, the proposed low-traumatic method of treating IMH with the preservation of foveal ILM provides a stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea zone. Key words: macular rupture, internal limiting membrane, chromovitrectomy.

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 Analysis of surgical treatment results of macular holes in the Samara region

2017 ◽  
Vol 98 (3) ◽  
pp. 397-400
Author(s):  
D V Petrachkov ◽  
A V Zolotarev ◽  
P A Zamytskiy ◽  
E V Karlova ◽  
I S Kazakov
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
Medical Records ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Aim Analysis ◽  
Corrected Visual Acuity ◽  
Macular Holes ◽  
Ophthalmic Hospital ◽  
Hole Closure

Aim. Analysis of anatomical and functional results of surgical treatment of full-thickness macular holes. Methods. We conducted a retrospective analysis of medical records of 194 outpatients (194 eyes) on whom surgical treatment of macular hole was performed in Samara Clinical Ophthalmic Hospital n.a. T.I. Eroshevskiy during 2015-2016. Results. On day 5 after surgery in 96 (97.9%) patients with a hole of more than 400 µm operated according to inverted flap technique, and in 93 (96.9%) patients with hole of less than 400 µm, on whom removal of the internal limiting membrane around the hole was performed, we observed macular hole closure. The best corrected visual acuity of patients with the hole of more than 400 µm increased to 0.18±0.13 (p

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.

scholarly journals Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

2018 ◽  
Vol 1 (1) ◽  
pp. 07-13
Author(s):  
Ogugua Ndubuisi Okonkwo ◽  
Adekunle Olubola Hassan ◽  
Olufemi Oderinlo
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Vital Role ◽  
Symptom Duration ◽  
Flap Technique ◽  
Macular Holes ◽  
Snellen Visual Acuity ◽  
Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

scholarly journals Surgical treatment of «dry» forms of central chorioretinal dystrophy with the use of platelet-rich blood autoplasma

2017 ◽  
Vol 98 (3) ◽  
pp. 390-393
Author(s):  
D G Arsjutov
Keyword(s):  
Surgical Treatment ◽  
Pigment Epithelium ◽  
Vitreoretinal Surgery ◽  
Internal Limiting Membrane ◽  
Hyaline Membrane ◽  
The Impact ◽  
Observation Period ◽  
Subretinal Injection ◽  
Sodium Solution

Aim. To study the impact of platelet-rich blood autoplasma on the capability of the retinal regeneration in nonexudative forms of central chorioretinal dystrophy with the use of microinvasive vitreoretinal surgery. Methods. Surgical treatment was performed on 14 patients with central chorioretinal dystrophy aged 29 to 87 years. The surgery technique consisted of 3-port 25+, 27 Ga vitrectomy with posterior hyaline membrane and internal limiting membrane peel with subsequent central retinal exfoliation with 38 Ga cannula and balanced sodium solution and subretinal injection to the formed in macule space 0.1-0.2 ml of platelet-rich autolplasma. Results. As a result of the treatment according to this technique during the long-term period after the surgery (1 to 9 months) thickness of fovea reduced to 85-150 µm in average staying stable during the whole observation period. In 9 patients pigment epithelium thickened from 24 to 38 µm in parafoveolar area and fovea area. Corrected vision in 3 patients reached 0.1, and in the rest it did not exceed 0.06, herewith, all patients noted consistently improved vision. All patients had favorable evolution of photosensitivity according to microperimetry in average from 0.1-0.5 to 8.5-11 dB with a tendency of fixation point movement from periphery to the center. Conclusion. Vitreoretinal surgery 25+, 27 Ga for nonexudative forms of central chorioretinal dystrophy with the use of subretinal injection of platelet-rich autoplasma is a microinvasive, safe, effective method of the treatment of such pathology improving vision characteristics and anatomical and physiological characteristics of the eye involved.

Morphofunctional analysis of the retina in the surgical treatment of idiopathic macular holes

2021 ◽  
pp. 48-52
Author(s):  
A.S. Zotov ◽  
◽  
A.S. Balalin ◽  
S.V. Balalin ◽  
S.M. Purshak ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Surgical Treatment ◽  
Macular Hole ◽  
Practical Importance ◽  
Functional Results ◽  
Hole Diameter ◽  
Optical Coherence ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
Morphofunctional Analysis

Purpose. To evaluate the role of microperimetry and optical coherence tomography (OCT) in the morphofunctional analysis of the retina after surgical treatment of idiopathic macular holes (IMH). Materials and methods. A retrospective study of 33 patient's treatment results (33 eyes) with IMH was carried out. All patients underwent minimally invasive with 25G or 27G vitrectomy. Best corrected visual acuity (BCVA), macular photosensitivity, fixation stability, macular neuroepithelial (NE) volume and minimal macular hole diameter were analyzed. Follow-up period: 6 months. Results. A complete closure of the macular hole was achieved in all cases post-op. The patients had reliable improvement of BCVA, retinal photosensitivity and decrease of macular NE volume. Based on a multifactor correlation analysis with the purpose to predict the results of surgical treatment, the dependence of post-op BCVA on the pre-op photosensitivity of the retina and the minimal diameter of the macular hole was revealed. Conclusions. Microperimetry and OCT are modern non-invasive research methods allowing to estimate anatomical and functional results of surgical IMH treatment. The study of retinal photosensitivity in the macula and minimal macular hole diameter pre-op allows to predict post-op BCVA, which has a practical importance. Keywords: idiopathic macular hole, vitrectomy, microperimetry, optical coherence tomography.

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