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.

Vitreoretinal surgery for retinal detachments in children is an effective, sometimes the only method to restore vision. As practice shows, the use of minimally invasive regional techniques is increasingly used for combined anesthesia in ophthalmic surgery in children. In the postoperative period, the use of blockades can provide prolonged analgesia, thereby improving the childs comfort level after the surgery. All types of blockades in ophthalmology have certain risks, but the pterygopalatine blockade has not any, since it is performed outside the eye structures. The research of the use of the pterygopalatine blockade after surgery in children is important not only for creating prolonged analgesia, but also for reducing vegetative reactions that can complicate the recovery period. Purposeof the study isto increase the pain management efficacy in the postoperative period in children who have undergone extensive surgery for retinal detachment. Materials and methods. 1st group (n= 32) received postoperative analgesia pterygopalatine blockage with ropivacaine 0.5%, 2nd group (n= 28) systemic analgesia. Changes in hemodynamics and stress index in the postoperative period were evaluated. Cortisol levels in the intensive care unit was evaluated in 2 hours later. The time and frequency use of antiemetics in the occurrence of PONV were recorded. The level of patients comfort after surgery and the pain intensity were evaluated on an integral scale and on the Verbal Rating Scale (VRS) in points. Results.The children of 1st group did not have significant changes in heart rate and SBP in the intensive care unit. In group 1, the TI decreased by 13.2% in the intensive care unit, and in group 2, the TI increased by 28.5% after 2 hours and by 88.6% after 8 hours. 2 hours after the surgery pain was 2 points in 12.5% of the patients (1st group) and 39.2% of patients (2nd group). After 8 hours, 35.7% of patients (2nd group) reported moderate pain that required medication. There were no PONV in group 1, and it occured in 28.5% of patients in group 2. In group 1, 75% of children rated the postoperative period as comfortable, and in group 2 21.4% (p 0,05). Conclusion. Pterygopalatine blockade as the main method of postoperative analgesia in the early postoperative period has got a long-term analgesic effect, reducing the frequency of nausea and vomiting, improving the quality of the postoperative period in children.

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