Modern approaches to the surgical treatment of large full-thickness macular holes

Abstract

Vitreoretinal surgery is an actively developing area of modern ophthalmic surgery. Intravitreal interventions in the central retina with large full-thickness macular holes deserve special attention. This article provides an overview of the scientific literature published in journals recommended by the Higher Attestation Commission, also presented in the scientific databases Scopus, PubMed, dedicated to modern techniques to the surgical treatment of large full-thickness macular holes. The main methods for closing defects in the macular area today are the use of various modifications of the inverted internal limiting membrane flap technique and the application of autologous platelet rich plasma in a macular hole. These techniques provide high anatomical and functional outcomes. Modifications of the inverted internal limiting membrane flap technique demonstrated effectiveness in such complex clinical situations as recurrent macular holes, concomitant high myopia, retinal detachment. Over the past 10 years, data on the use of autologous platelet-rich plasma for this group of patients appeared in the scientific literature. More accurate surgical procedures are required for the use of this technique compared with the standard methods, but this technique is applicable in all patients, does not require additional manipulations (blood sampling and centrifugation), additional equipment. Vitreoretinal interventions with the use of platelet-rich plasma are characterized by relative simplicity and ease of carrying out surgical procedures. However, it is important to consider the possibility of pseudouveitis development, the need for additional equipment. Since both of these methods demonstrate good anatomical results, the problem of choosing a technique in a particular clinical case remains. It was clear that the method of surgical intervention should be chosen, taking into account possible disadvantages and limitations to the method, as well as the skills of an ophthalmic surgeon. The lack of a unified approach to macular hole surgery encourages researchers to improve surgical techniques, develop and implement new modifications of surgical approaches.

Keywords

macular holes / inverted internal limiting membrane flap technique / displaced internal limiting membrane flap / Platelet-rich plasma / PRP / Autologous Conditioned Plasma / ACP

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