Modern technology of surgical treatment for central retinal detachment with macular hole in patients with highly complicated myopia and scleral staphyloma

Abstract

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.