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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.
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.
Introduction. At present the major problem is the imperfection of the surgical approaches and the effectiveness of the surgical treatment for macular holes of various diameters associated with central retinal detachment in patients with high myopia and scleral staphyloma in the central zone. The main difficulty lies in creating the effective tamponade of the vitreous cavity necessary to close the macular hole. No less important is the effective blocking of the macular hole itself in the presence of deep scleral staphyloma. Silicone oils are currently used as a tamponing agent in most cases. Their viscous properties do not always allow the retina to be fully adapted. Searching for alternative highly effective methods of the surgical treatment for this pathology should increase anatomical and functional effectiveness of the treatment.The aim of this work is to develop the methodology and analyze the results of the surgical treatment of patients with central retinal detachment against the background of the macular holes of various diameters in patients with high myopia and scleral staphyloma using autologous conditioned plasma (ACP) as the blocking rupture composite and pneumoretinopexy as the final tamponade.Material and methods. Surgical tactics included subtotal vitrectomy 25+, 27G, peeling of the inner limiting membrane, pneumoretinopexy, introduction of ACP into the area of scleral staphyloma through the macular hole. After formation of the plasma seal at the base ACP was applicated to the surface of the retina in the hole area in 2–3 layers up to formation of the resistant ACP layer. The operation was completed seamlessly, blocking the scleroconjunctival access by applying 2–3 layers of ACP to the surface of the sclera and conjunctiva. Using this technique, 22 patients with central retinal detachment and macular hole with a diameter of 700–2200 microns against the background of high myopia and with severe scleral staphyloma were operated.Results. As a result of the treatment, in the early and late postoperative period the retina was completely adjacent and the macular hole was blocked in all the patients.Conclusion. In this way, this technique is the most sparing and highly effective. It allows to achieve the full anatomical fit of the retina and the closure of the macular hole, to eliminate the need for silicone tamponade, to minimize the risk of the postoperative complications in patients with central retinal detachment and the macular holes of various diameters in patients with high myopia and scleral staphyloma.
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