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.

The main treatment for macular holes is vitrectomy with peeling of the internal limiting membrane, however, despite the rapid development of macular surgery, the percentage of negative anatomical results after primary surgery remains high. The aim of this work was to evaluate and compare the functional parameters of the central part of the retina using surgical techniques for blocking unclosed macular holes (creating a ILM-free flap in combination with silicone oil tamponade, or creating a ILM-free flap with the application of an ACP mass and tamponade with a gas-air mixture). Material and methods. This study involved 42 patients, the patients were divided into groups in accordance with the technique of reoperative intervention, all patients underwent microperimetry. Results. The retinal photosensitivity along the small radius in patients in the group with tamponade with a gas-air mixture is 1.11 times higher than in patients with silicone oil tamponade, 1.51 times higher in the middle radius, 1.53 times higher in the large radius. Conclusions. In the 2nd group the photosensitivity indicators were higher than in 1st group of patients with using silicone oil tamponade, which can be explained by the negative effect of silicone oil on the macular area. Key words: macular rupture, rigid, free flap, silicone oil, ACP mass, microperimetry.

Purpose. To assess the morphological parameters of the central retina in different groups with unblocked macular rupture after primary surgery for macular rupture (MR). Material and methods. This study involved 32 patients (35 eyes), including 19 women, 13 men. 3 groups were formed according to the principle of primary surgery. All patients underwent standard ophthalmological examinations, as well as optical coherence tomography (OCT). Results. According to OCT data, the morphological and functional parameters were different depending on the primary method of surgical treatment. The diameter of the MR along the large and small radius is the biggest in the 3rd group. The area of edema in the analysis of various methods of surgical treatment did not differ statistically. Conclusion. The functional parameters of the central part of the retina do not depend on the initial method of surgical intervention. The use of mechanical action on the retina causes rigidity of the edges of the macular rupture, and when using an introverted flap, the small and large diameters of the macular rupture remain minimal, in contrast to the use of platelet mass and mechanical closure of the MR. Key words: macular hole, platelet rich mass, introverted flap, mechanical closure, rigid.