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

2021 ◽  
Vol 6 (6-1) ◽  
pp. 159-167
Author(s):  
D. I. Bronskiy ◽  
S. I. Zhukova ◽  
V. A. Zaika ◽  
A. G. Shchuko
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Large Diameter ◽  
Central Zone ◽  
Internal Limiting Membrane ◽  
Foveal Avascular Zone ◽  
Traditional Research ◽  
Structural Relationships ◽  
Macular Holes ◽  
A Prospective Study

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.

Assessment of the clinical effectiveness of idiopathic macular ruptures surgical treatment of a large and medium diameter using modified inverted flap technology of internal limiting membrane (preliminary results)

2021 ◽  
pp. 20-25
Author(s):  
D.I. Bronskiy ◽  
◽  
V.A. Zaika ◽  
A.P. Yakimov ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Free Flap ◽  
Large Diameter ◽  
Clinical Effectiveness ◽  
Internal Limiting Membrane ◽  
Treatment Method ◽  
Retinal Blood Flow ◽  
Photoreceptor Layer ◽  
Layer 4 ◽  
A Prospective Study

Purpose. To assess the clinical effectiveness of surgical treatment of medium-and large-diameter idiopathic macular ruptures (IMR) using a modified technology by inversion and fixation of a free flap of the internal limiting membrane (ILM). Methods. A prospective study was conducted in 11 patients (11 eyes), 9 women and 2 men with medium-and large-diameter IMR. Mean age - 67.3 ± 5.38 (55-80) years. Patients with penetrating IMR of 2-4 stages according to the J. Gass classification. All patients underwent optical coherence tomography (OCT) along with traditional ophthalmological methods. The scans were performed in Retina Map, Cross line, Radial line, and Angio Retina modes. The obtained images were used to measure the parameters of the macular rupture (MR) of the retina manually. All patients underwent surgical treatment of IMR according to the proposed method. Results. In all cases, 1 day after the surgery, the closure of the gap was achieved according to ophthalmoscopy. 1 month after the surgery, according to OCT, 3 patients (27.2%) had a defect in the photoreceptor layer, 4 patients (36.3%) had deformity or peripheral non-attachment of the edges of the ILM flap, and 2 patients (18.1%) had a combination of these defects. According to OCT data in the Angio Retina mode, changes in the parameters of retinal blood flow were noted: there was a significant, moderate expansion of the avascular zone, accompanied by a moderate decrease in retinal perfusion. Despite this, there was a significant increase in visual acuity in the postoperative period. Conclusion. Endovitreal intervention for medium-and large-diameter macular ruptures using a modified technology by inversion and fixation of an ILM free flap is highly effective, as well as a low-traumatic treatment method that allows achieving anatomical closure of the macular defect and improving visual functions.

Surgical treatment of large idiopathic macular ruptures with petals of the internal limiting membrane with incisions

2021 ◽  
pp. 36-39
Author(s):  
K.U. Eremenko ◽  
◽  
V.U. Maksimov ◽  
N.N. Aleksandrova ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Visual Function ◽  
Large Diameter ◽  
Internal Limiting Membrane ◽  
Clinical Results ◽  
The Stability ◽  
Incomplete Closure ◽  
Old Men

Purpose. To study the results of surgical treatment of patients with large diameter idiopathic macular breaks by the proposed method of closing the defect with inverted petals of the internal limiting membrane with incisions. Material and methods. There were analyzed clinical results of surgical treatment of idiopathic macular breaks (IMB) by closing the defect with inverted lobes of the internal limiting membrane with incisions in 25 patients (25 eyes) between 45 and 63 years old. Men – 11 (44%), women – 14 (56%). Terms of treatment in the hospital since the appearance of changes in visual functions: 6 patients after 1.5-2 years, 19 patients after 6-8 months. Visual acuity at admission was: 0.01 in 4 patients; 0.02 in 5; 0.03 in 5; 0.06-0.09 in 6; 0.1-0.3 in 5. Macular ruptures were stage III, diameter from 450 to 730 microns (on average, 594.52± 114.06 microns). The follow-up period is 3 years. Results. In 25 patients underwent 25G endovitreal intervention with closing of the macular hole with the petals of internal limiting membrane. The visual acuity improvement was observed in 23 patients: up to 0,1 – 0,6 – in 20; up to 0,09 – in 3. In 2 patients visual acuity was 0.01-0.02, this may be due to incomplete closure of the macular opening and the duration of the disease. After 3 years of visual function remained stable. Conclusion. The use of inverted petals of internal limiting membrane in the treatment of large diameter IMB contributes to the closure of the macular breaks and restoration of the anatomical profile of the macular in 92% of cases. The increase of visual acuity up to 0.1 – 0.6 in 80% of cases. The stability of clinical results up to 3 years allows us to recommend this method of treatment in practice.

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. 

Platelet-rich plasma in surgery of various diameters idiopathic macular holes

2021 ◽  
pp. 51-53
Author(s):  
R.Z. Shamratov ◽  
◽  
L.S. Ramazanova ◽  
O.A. Napylova ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Macular Hole ◽  
Platelet Rich Plasma ◽  
Internal Limiting Membrane ◽  
Treatment Method ◽  
Macular Holes ◽  
Key Words Macular Hole ◽  
Promising Treatment ◽  
Idiopathic Macular Holes

The tactics of surgical treatment of the macular hole can be different and depends on the stage and diameter of the disease. Purpose. To study the results of surgical treatment of idiopathic macular detachments of various diameters with the use of autoplasma enriched with platelets. Material and methods. We observed 15 patients (15 eyes). Internal limiting membrane was peeled after vitrectomy. Platelet-rich autoplasmа was injected intravitreally. The observation period was 1 month. Results. As a result of surgical treatment, we were able to close the opening in all cases, restore the anatomy of the fovea and improve visual acuity in all patients. Conclusion. According to the assessment of the results obtained in the ongoing study, the use of this technology is an effective and promising treatment method based on the stimulation of the tissues' own regenerative potential. Key words: macular hole, surgical treatment, vitrectomy, platelet-rich plasma, visual acuity.

Analysis of results of inverted internal limiting membrane flap technique using 3D visualization for surgical treatment of macular holes

2021 ◽  
pp. 31-35
Author(s):  
A.V. Egorov ◽  
◽  
O.V. Kolenko ◽  
A.Y. Khudyakov ◽  
V.V. Egorov ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
High Efficiency ◽  
Silicone Oil ◽  
3D Visualization ◽  
Internal Limiting Membrane ◽  
Visualization System ◽  
Flap Technique ◽  
Macular Holes ◽  
Analysis Of Results

Purpose. Analysis of results of inverted internal limiting membrane (ILM) flap technique using 3D visualization for surgical treatment of macular holes (MH). Material and methods. 21 people with stage 3 or 4 MH. Visometry and optical coherence tomography (OCT) were performed before surgery, on the 3rd day and 1 month after surgery. All patients underwent a three-port 27G vitrectomy with using NGENUITY 3D visualization system (Alcon, USA). After vitrectomy and ILM staining, the ILM flap was formed in the form of single monoblock with wide base, which was turned over and placed on the MH area. The operation was completed by fluid/air exchange. Results. MH closure on the 3rd day after surgery was observed in 19 (90.5%) of 21 patients. In 2 patients, MH closure was absent; in these cases, a second operation was performed with silicone oil tamponade. One month after the operation, according to OCT datas, complete MH closure was noted in all patients. The average value of the best corrected visual acuity by this observation period was 0.3, which was 6 times higher than the initial (0.05) visual acuity. The use of 3D visualization system allowed us to reduce the level of endoillumination by up to 15% and to reduce the exposure time of the endovitreal dye to 15 seconds to reduce the risks of retinal phototoxicity. Conclusion. The proposed inverted ILM flap technique made it possible to achieve MH closure in 90.5% of cases. The experience of using NGENUITY 3D visualization system has shown high efficiency and safety by reducing the risk of iatrogenic phototoxicity. Key words: macular hole, inverted flap, internal limiting membrane, 3D visualization, NGENUITY.

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.

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.

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience

2020 ◽  
Author(s):  
Nisa Silva ◽  
Natália Ferreira ◽  
Bernardete Pessoa ◽  
Nuno Correia ◽  
João Melo Beirão ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Limiting Membrane ◽  
Flap Technique ◽  
Macular Holes

Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes

2016 ◽  
Vol 132 (1) ◽  
pp. 23
Author(s):  
Yu. A. Belyy ◽  
A. V. Tereshchenko ◽  
D. O. Shkvorchenko ◽  
E. V. Erokhina ◽  
N. M. Shilov
Keyword(s):  
Surgical Treatment ◽  
Internal Limiting Membrane ◽  
Membrane Fragment ◽  
Macular Holes ◽  
Idiopathic Macular Holes

scholarly journals Outcomes of Inverted Internal Limiting Membrane Flap Technique for Large Idiopathic Macular Holes Surgery in Patients at A Tertiary Care Hospital

2019 ◽  
Vol 57 (217) ◽  
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokhrel ◽  
Om Krishna Malla
Keyword(s):  
Visual Acuity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Internal Limiting Membrane ◽  
Care Hospital ◽  
Base Diameter ◽  
Flap Technique ◽  
Macular Holes ◽  
Idiopathic Macular Holes ◽  
The Mean

Introduction: Large macular holes cause significant reduction in central visual acuity. The aim ofthe study is to find out short term anatomical and visual outcomes of inverted internal limitingmembrane flaps technique for large macular holes (base diameter>1000μm) surgery in patientsat a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital fromJanuary 2018 to December 2018 after ethical clearance from the institutional review committee.The study was done in 12 patients with idiopathic macular holes (base diameter>1000μm), theywere repaired with 25 gauge pars plana vitrectomy with brilliant blue assisted large invertedinternal limiting membrane flap technique. Statistical analyses were performed using SPSS 19.0. Results: All twelve eyes had complete anatomical closure. Mean best corrected visualacuity preoperatively was 1.48 logMAR±0.246. The mean macular hole base diameter was1217.0±196.77μm. The mean age of patients was 68.75±4.97 years. Postoperatively,mean best corrected visual acuity was 0.978 logMAR±0.12. There were no postoperativecomplications. All the patients perceived decreased size of central scotoma. Conclusions: Inverted internal limiting membrane flaps for large macular holes is suitable methodfor closure of the very large hole, restoration of functional vision and decreased size of centralscotoma.

Sign in / Sign up

Export Citation Format

Share Document