Analysis of the surgical treatment results of large idiopathic macular holes using tamponade with internal limiting membrane flaps and platelet-rich plasma

Abstract

BACKGROUND: Penetrating macular holes of the retina remain today one of the main reasons for a significant loss of central vision, especially in working age patients. At the same time, the mainstream problem are the validity and effectiveness of treatment of large and giant macular holes with a diameter of more than 500–1000 µm.

AIM: to optimize the treatment method for patients with large and long-standing macular holes. To analyze the results of treatment of patients with this condition.

MATERIALS AND METHODS: In 2023, 56 patients were operated on for idiopathic large macular hole. During vitrectomy, a new surgical technique was used for the macular hole bed tamponade with flaps of the internal limiting membrane in combination with the introduction of platelet-rich plasma.

RESULTS: After the resorption of the gas-air mixture (1–1.5 months after surgery), ophthalmoscopically and according to optical coherence tomography data, closure of the macular hole was observed in 51 of 56 operated patients, which amounted to 91.1%.

CONCLUSIONS: The surgical treatment technique used allows for closure of large macular holes in 91.1%.

Keywords

macular hole / microinvasive vitrectomy / platelet-rich plasma / internal limiting membrane

References

[1] Faizrakhmanov RR, Shishkin MM, Pavlovsky OA, Larina EA. Operative treatment of macular rupture. Ufa: Bashkirskaya encyclopedia; 2020. P. 15. EDN: HHAKSC

[2] Файзрахманов Р.Р., Шишкин М.М., Павловский О.А., Ларина Е.А. Оперативное лечение макулярного разрыва, Уфа: Баширская эциклопедия, 2020. С. 15. EDN: HHAKSC

[3] Faizrakhmanov RR, Shishkin MM, Pavlovsky OA, Larina EA. Operative treatment of macular rupture. Ufa: Bashkirskaya encyclopedia; 2020. P. 15. EDN: HHAKSC

[4] McCannel CA, Ensminger JL, Diehl NN, Hodge DN. Population-based incidence of macular holes. Ophthalmology. 2009;116(7); 1366–1369. doi: 10.1016/j.ophtha.2009.01.052

[5] McCannel C.A., Ensminger J.L., Diehl N.N., Hodge D.N. Population-based incidence of macular holes // Ophthalmology. 2009. Vol. 116, N 7. P. 1366–1369. doi: 10.1016/j.ophtha.2009.01.052

[6] McCannel CA, Ensminger JL, Diehl NN, Hodge DN. Population-based incidence of macular holes. Ophthalmology. 2009;116(7); 1366–1369. doi: 10.1016/j.ophtha.2009.01.052

[7] Faizrakhmanov RR, Larina EA, Pavlovsky OA. Surgical treatment of previously unclosed macular holes. Ophthalmology in Russia. 2020;17(3): 368–374. EDN: JGJJAG doi: 10.18008/1816-5095-2020-3-368-374

[8] Файзрахманов Р.Р., Ларина Е.А., Павловский О.А. Оперативное лечение ранее оперированных не закрывшихся макулярных разрывов // Офтальмология. 2020. Т. 17, № 3. С. 368–374. EDN: JGJJAG doi: 10.18008/1816-5095-2020-3-368-374

[9] Faizrakhmanov RR, Larina EA, Pavlovsky OA. Surgical treatment of previously unclosed macular holes. Ophthalmology in Russia. 2020;17(3): 368–374. EDN: JGJJAG doi: 10.18008/1816-5095-2020-3-368-374

[10] Zhigulin AV, Khudyakov AYu, Lebedev YaB, Mashchenko NV. Silicone tamponade efficiency in surgical treatment of macular holes of big diameter. Fyodorov Journal of Ophthalmic Surgery. 2013;(1):6–8. EDN: PYDPKR

[11] Жигулин А.В., Мащенко Н.В., Лебедев Я.Б., Малютин И.И. Результаты хирургического лечения макулярных разрывов большого диаметра // Современные технологии в офтальмологии. 2023. № 3. С. 158–162. EDN: UTBQRX doi: 10.25276/2312-4911-2023-3-158-162

[12] Zhigulin AV, Khudyakov AYu, Lebedev YaB, Mashchenko NV. Silicone tamponade efficiency in surgical treatment of macular holes of big diameter. Fyodorov Journal of Ophthalmic Surgery. 2013;(1):6–8. EDN: PYDPKR

[13] Bikbov MM, Altynbaev UR, Gilmanshin TR. Selecting the method of intraoperative closing of large idiopathic macular hole. Fyodorov Journal of Ophthalmic Surgery. 2010;(1):25–28. EDN: PXQZPF

[14] Бикбов М.М., Алтынбаев У.Р., Гильманшин Т.Р. Выбор способа интраоперационного закрытия идиопатического макулярного разрыва большого диаметра // Офтальмохирургия. 2010. № 1. С. 25–28. EDN: PXQZPF

[15] Bikbov MM, Altynbaev UR, Gilmanshin TR. Selecting the method of intraoperative closing of large idiopathic macular hole. Fyodorov Journal of Ophthalmic Surgery. 2010;(1):25–28. EDN: PXQZPF

[16] Lappas А, Foerster A, Kirchhof B. Use of heavy silicon oil (Densiron-68) in the treatment of persistent macular holes. Acta Ophthalmol. 2009;87(8):866–870. doi: 10.1111/j.1755-3768.2008.01371.x

[17] Lappas А., Foerster A., Kirchhof B. Use of heavy silicon oil (Densiron-68) in the treatment of persistent macular holes // Acta Ophthalmol. 2009. Vol. 87, N 8. P. 866–870. doi: 10.1111/j.1755-3768.2008.01371.x

[18] Lappas А, Foerster A, Kirchhof B. Use of heavy silicon oil (Densiron-68) in the treatment of persistent macular holes. Acta Ophthalmol. 2009;87(8):866–870. doi: 10.1111/j.1755-3768.2008.01371.x

[19] Rizzo S. Heavy silicon oil (Densiron-68) for the treatment of persistent macular holes. Graefe’s Arch Clin and Exp Ophthal. 2009;247(11):1471–1476. doi: 10.1007/s00417-009-1131-5

[20] Rizzo S. Heavy silicon oil (Densiron-68) for the treatment of persistent macular holes // Graefe’s Arch Clin and Exp Ophthal. 2009. Vol. 247, N 11. P. 1471–1476. doi: 10.1007/s00417-009-1131-5

[21] Rizzo S. Heavy silicon oil (Densiron-68) for the treatment of persistent macular holes. Graefe’s Arch Clin and Exp Ophthal. 2009;247(11):1471–1476. doi: 10.1007/s00417-009-1131-5

[22] Petrachkov DV, Zolotarev AV, Zamytsky PA, et al. Analysis of surgical treatment results of macular holes in the samara region. Kazan Medical Journal. 2017;98(3):397–400. EDN: YPCQJD doi: 10.17750/KMJ2017-397

[23] Петрачков Д.В., Золотарев А.В., Замыцкий П.А., и др. Анализ результатов хирургического лечения сквозных макулярных разрывов в Самарской области // Казанский медицинский журнал. 2017. Т. 98. N 3, С. 397–400. EDN: YPCQJD doi: 10.17750/KMJ2017-397

[24] Petrachkov DV, Zolotarev AV, Zamytsky PA, et al. Analysis of surgical treatment results of macular holes in the samara region. Kazan Medical Journal. 2017;98(3):397–400. EDN: YPCQJD doi: 10.17750/KMJ2017-397

[25] Arsyutov DG, Andreev AN. Surgical approach for treating large and giant macular rupture. Point of View. East–West. 2016;(1):97–98. EDN: WHCNUZ

[26] Арсютов Д.Г., Андреев А.Н. Хирургическая тактика при лечении больших и гигантских макулярных разрывов // Точка зрения. Восток–Запад. 2016. № 1. С. 97–98. EDN: WHCNUZ

[27] Arsyutov DG, Andreev AN. Surgical approach for treating large and giant macular rupture. Point of View. East–West. 2016;(1):97–98. EDN: WHCNUZ

[28] Rizzo S, Tartaro R, Barca F. Internal imiting membrane pelling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38(Suppl 1):S73–S78. doi: 10.1097/IAE.0000000000001985

[29] Rizzo S., Tartaro R., Barca F. Internal imiting membrane pelling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients // Retina. 2018. Vol. 38, Suppl 1. P. S73–S78. doi: 10.1097/IAE.0000000000001985

[30] Rizzo S, Tartaro R, Barca F. Internal imiting membrane pelling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38(Suppl 1):S73–S78. doi: 10.1097/IAE.0000000000001985

[31] Hu Z, Lin H, Liang Q, Wu R. Comparing the inverted internal limiting membrane flap with autologous blood technique to internal limiting membrane insertion for the repair of refractory macular hole. Int Ophthalmol. 2020;40(1):141–149. doi: 10.1007/s10792-019-01162-0

[32] Hu Z., Lin H., Liang Q., Wu R. Comparing the inverted internal limiting membrane flap with autologous blood technique to internal limiting membrane insertion for the repair of refractory macular hole // Int Ophthalmol. 2020. Vol. 40, N 1. P. 141–149. doi: 10.1007/s10792-019-01162-0

[33] Hu Z, Lin H, Liang Q, Wu R. Comparing the inverted internal limiting membrane flap with autologous blood technique to internal limiting membrane insertion for the repair of refractory macular hole. Int Ophthalmol. 2020;40(1):141–149. doi: 10.1007/s10792-019-01162-0

[34] Agrawal V, Jindal K, Dhakad Y, et al. Multilayered inverted internal limiting membrane flap technique versus standard internal limiting membrane peeling for large macular holes: A comparative study. Indian J Ophthalmol. 2022;70(3):909–913. doi: 10.4103/ijo.IJO_1530_21

[35] Agrawal V., Jindal K., Dhakad Y., et al. Multilayered inverted internal limiting membrane flap technique versus standard internal limiting membrane peeling for large macular holes: A comparative study // Indian J Ophthalmol. 2022. Vol. 70, N 3. P. 909–913. doi: 10.4103/ijo.IJO_1530_21

[36] Agrawal V, Jindal K, Dhakad Y, et al. Multilayered inverted internal limiting membrane flap technique versus standard internal limiting membrane peeling for large macular holes: A comparative study. Indian J Ophthalmol. 2022;70(3):909–913. doi: 10.4103/ijo.IJO_1530_21

[37] Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina. 2015;35(9):1844–1850. doi: 10.1097/IAE.0000000000000555

[38] Michalewska Z., Michalewski J., Dulczewska-Cichecka K., et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study // Retina. 2015. Vol. 35, N 9. P. 1844–1850. doi: 10.1097/IAE.0000000000000555

[39] Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina. 2015;35(9):1844–1850. doi: 10.1097/IAE.0000000000000555

[40] Zhigulin AV, Mashchenko NV, Lebedev YaB, Malyutin II. Results of surgical treatment of large diameter macular holes. Modern Technologies in Ophthalmology. 2023;(3):158–162. EDN: UTBQRX doi: 10.25276/2312-4911-2023-3-158-162

[41] Жигулин А.В., Худяков А.Ю., Лебедев Я.Б., Мащенко Н.В. Эффективность силиконовой тампонады в хирургическом лечении макулярных разрывов большого диаметра // Офтальмохирургия. 2013. № 1. C. 6–8. EDN: PYDPKR

[42] Zhigulin AV, Mashchenko NV, Lebedev YaB, Malyutin II. Results of surgical treatment of large diameter macular holes. Modern Technologies in Ophthalmology. 2023;(3):158–162. EDN: UTBQRX doi: 10.25276/2312-4911-2023-3-158-162

[43] Andrew N, Chan WO, Tan M, et al. Modification of the inverted internal limiting membrane flap technique for the treatment of chronic and large macular holes. Retina. 2016;36(4):834–837. doi: 10.1097/IAE.0000000000000931

[44] Andrew N., Chan W.O., Tan M., et al. Modification of the inverted internal limiting membrane flap technique for the treatment of chronic and large macular holes // Retina. 2016. Vol. 36, N 4. P. 834–837. doi: 10.1097/IAE.0000000000000931

[45] Andrew N, Chan WO, Tan M, et al. Modification of the inverted internal limiting membrane flap technique for the treatment of chronic and large macular holes. Retina. 2016;36(4):834–837. doi: 10.1097/IAE.0000000000000931

[46] Tereshchenko AV, Trifanenkova IG, Shpak AA, Shilov NM. Forecasting the anatomic result of surgical treatment of large idiopathic macular holes. Practical Medicine. 2017;2(9):222–226. EDN: ZNLUBJ

[47] Терещенко А.В., Трифаненкова И.Г., Шпак А.А., Шилов Н.М. Прогнозирование анатомического результата хирургического лечения больших идиопатических макулярных разрывов // Практическая медицина. 2017. Т. 2, № 9. С. 222–226. EDN: ZNLUBJ

[48] Tereshchenko AV, Trifanenkova IG, Shpak AA, Shilov NM. Forecasting the anatomic result of surgical treatment of large idiopathic macular holes. Practical Medicine. 2017;2(9):222–226. EDN: ZNLUBJ

RIGHTS & PERMISSIONS

Eco-Vector