Цель: представить технику хирургического лечения макулярного разрыва (МР) без использования тампонады витреальной полости газом или другим заменителем стекловидного тела. Пациенты и методы. Частота заболевания-3 случая на 10 000, чаще после 55 лет-3-3,3 случая на 1000, а пик приходится на возраст 60 лет и старше. По современным данным, частота закрытия МР после витреальной хирургии варьирует от 68 до 98 %. В настоящем исследовании представлены результаты лечения 16 пациентов (16 глаз) со сквозным макулярным разрывом размерами от 100 до 932 мкм (558,5 ± 50,9). Острота зрения составила от 0,04 до 0,2 (0,09 ± 0,01) с коррекцией. Время наблюдения за пациентами, прооперированными по данной технологии, составило от 2 недель до 4 месяцев (9,0 ± 6,3). Результаты. Операционных и послеоперационных осложнений ни в одном случае не было. В результате хирургического лечения полное закрытие макулярного разрыва и анатомическое восстановление макулы достигнуто у 15 из 16 пациентов, что соответствует 92,8 %. Острота зрения после операции составила от 0,2 до 0,6 (0,4 ± 0,04) с коррекцией. Рецидив в одном случае был связан с нарушением технологии операции, при котором произошло частичное механическое смещение пленки фибрина канюлей при замене ПФОС на воздух. Выводы. Предлагаемый метод хирургического лечения макулярного разрыва без использования послеоперационной тампонады витреальной полости газом или каким-либо другим заместителем стекловидного тела может быть использован в повседневной врачебной практике. Преимущества предложенного метода: не требуется вынужденное положение пациента лицом вниз; зрение после операции в 1-й день находится на предоперационном уровне или выше; снижается риск развития катаракты и повышения ВГД в послеоперационном периоде; сохраняется возможность перелетов и подъема на высоту в раннем послеоперационном периоде. Ключевые слова: макулярный разрыв, обогащенная тромбоцитами плазма крови, тампонирующее вещество, витрэктомия Для цитирования: Клейменов А.Ю., Казайкин В.Н., Лизунов А.В. Хирургическое лечение макулярного разрыва без использования тампонады витреальной полости в послеоперационном периоде.

Purpose. To develop a method of circular buckle length calculation for optimization of circular scleral buckling in retinal detachment surgery.Methods. At the first stage of the study a formula for calculation of optimal circular scleral buckle length for patients with various axial length (AL) of the eyeball was developed (90 eyes). These healthy eyes were divided into three groups, 30 eyes in each: group 1 — AL 19 to 23.5 mm, group 2 — AL 23.6 to 27 mm, group 3 — AL over 27 mm. In all the groups AL and equatorial diameter of the eyeball were measured with ultrasound A- and B- scanning (Тomey UD8000, Tomey AL 3000). Mathematic estimation of equatorial eyeball diameter dependence on AL was performed using correlation and regression analysis and the formula for optimal circular buckle length calculation was derived. At the second stage the derived formula was used in clinic during retinal detachment surgery in 15 eyes of 15 patients aged 28 to 44 years (37.6 ± 2.6) with subtotal retinal detachment occupying 2 to 3 quadrants. Follow-up period was 1 to 4 months (2.3 ± 0.5). For control, in all patient’s intraoperative measurement of the eyeball circumference in equatorial zone was performed.Results. The first step of the study revealed high correlation coefficient (r) between AL and equatorial eyeball diameter in groups 1 and 2, 0.89 and 0.87, respectively. In group 3 correlation coefficient was 0.57 which shows moderate correlation between AL and equatorial eyeball diameter. Group 3 (AL > 27 mm) was not included in deriving the formula for circular buckle length calculation. Finally, regression equation was obtained and the following formula for circular buckle length calculation was derived: L = 0.9π (8.05 + 0.66 AL), where L — circular buckle length, π = 3.14, AL — axial length of the eyeball. At the second stage of the study (eyes with AL less than 27 mm) anatomical attachment of the retina was achieved in all 15 cases (100 %), elevation of the buckle was 1.44 to 1.6 mm (1.5 ± 0.02), circular buckle shortening made 10 % of the initial eyeball diameter. Control measurement of eyeball diameter in equatorial zone coincided with calculated values, that is, equaled the data obtained from presented formula and from preoperative ultrasound measurement of equatorial eyeball diameter.Conclusions. The derived formula for circular buckle length calculation is highly effective for eyes with AL less than 27 mm: provides optimal height of impression roll (approximately 1.5 mm), reduces the risk of postoperative complications, it is simple in use and shortens the operation time. For calculation of circular buckle length for eyes with AL over 27 mm it is reasonable to use the data of preoperative ultrasound A-scan measurement of equatorial diameter of the eyeball.

Purpose. To assess remote results of our method of macular hole (MH) surgery without postsurgical vitreous cavity tamponade.   Material and methods. 34 eyes of34 patients were operated for full-thickness MH 100 to 932 (558.5 ± 50.9) microns in diameter with no vitreous cavity tamponade. Before surgery, best corrected visual acuity (BCVA) was 0.02 to 0.25 (0.11±0.02). The operation included 3-port 25—27 G vitrectomy, separation of posterior hyaloid membrane, staining and removal of the internal limiting membrane (ILM) with subsequent ex­change of salt solution for air. The hole edges were passively (without touching the retina) pulled towards the center using an extrusion cannula through air supplied into the vitreous cavity under the pressure of 20—25 mm Hg. After that, 0.05 to 0.1 ml of platelet rich plasma (PRP) of the patient was applied to macular hole zone. In 2 minutes, a fibrin film was formed at the place of application which was pressed to the retina by injecting 0.5 ml of Perfluororganic Compound liquid (PFCL) into the vitreous cavity. PFCL was exposed for 3 minutes, whereupon it was passively aspirated. The operation was completed by air exchanged for salt solution. High specific weight of PFCL facilitated a tight adhe­sion of fibrin film to the retina. The follow-up period was 1 to 20 months (7.9±0.8 on average).   Results. After the surgery, complete closure of the macular hole was achieved in 32 of 34 cases (94.1%). No intraoperative or postoperative complications were observed. Postsurgical BCVA improved to 0.3—0,7(0.50 ± 0.05). At the initial stage of the study, a recurrence ofMH took place in two cases associated with partial mechanical displacement of the fibrin film by the cannula during PFCL removal.   Conclusions. The proposed method of macular hole surgery avoiding postoperative vitreous cavity tamponade with gas or another vitreous substitute is effective, speeds up the rehabilitation and may be used in routine clinical practice, especially in patients with the only seeing eye, those with a transparent lens, those who need to take a plane or rise at great heights soon after the surgery, as well as those at risk of increased IOP or unable to sustain a forced head position even for a short time span.