The method of closing macular holes with partial preservation of the internal limiting membrane

Fayzrakhmanov, R.R.; Pavlovskiy, O.А.; Larina, E.A.

doi:10.17116/oftalma202013601173

Cited by 10 publications

(2 citation statements)

References 4 publications

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“…В настоящее время появились единичные работы, описывающие новый способ воздействия на ВПМ -частичный пилинг с сохранением фрагментов. Указанный способ применяется в хирургическом лечении миопического тракционного фовеошизиса, с недавнего времени предложено применять его в лечении сквозных макулярных разрывов [17,18]. В лечении ДР и ДМО частичный пилинг ВПМ применяли Кислицина и соавт.…”

Section:  обсуждениеunclassified

Dosed Fovea-Sparing Internal Limiting Membrane Peeling in Diabetic Macular Edema Treatment (Clinical Observations)

Филиппов¹,

Петрачков²,

Барышев³

2023

Офтальмология. Восточная Европа

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Введение. Потребность в лечении офтальмологических осложнений сахарного диабета остается высокой ввиду неуклонного роста числа пациентов с данной патологией. Формы диабетического макулярного отека (ДМО), ассоциированные с наличием аномалий витреомакулярного интерфейса (АВМИ), требуют дифференцированного подхода к тактике ведения пациентов и технике выполнения витреоретинальных хирургических операций. Цель. Демонстрация возможностей метода дозированного центрсберегающего пилинга внутренней пограничной мембраны сетчатки (ДЦСП ВПМ) в лечении ДМО. Материалы и методы. Представлены два клинических наблюдения – случаи лечения ДМО с АВМИ с применением метода ДЦСП ВПМ. В обоих случаях пациентам проведено комбинированное лечение – факоэмульсификация катаракты с имплантацией интраокулярной линзы в сочетании с витрэктомией с мембранопилингом по методике ДЦСП ВПМ. Период послеоперационного наблюдения составил 12 месяцев. Результаты. В ходе динамического наблюдения в первые 3–6 месяцев после лечения отмечали положительную анатомо-функциональную динамику. К 6-му месяцу в обоих случаях выявлено развитие ДМО, что потребовало применения anti-VEGF-терапии. В случае 1 к 12-му месяцу наблюдения отмечали анатомическое улучшение, но за счет формирования твердого экссудата в области fovea centralis острота зрения оказалась ниже исходной. В случае 2 на фоне лечения отмечали медленную положительную динамику течения ДМО с сохранением зрительной функции на уровне послеоперационной. В обоих случаях не наблюдали интра- и послеоперационных осложнений пилинга ВПМ, таких как формирование ятрогенных разрывов сетчатки, отслойки нейроэпителия, развитие послеоперационного эпимакулярного фиброза. Заключение. ДЦСП ВПМ является примером метода протекции fovea centralis в ходе хирургического лечения. Указанные технологии являются перспективными, однако требуют изучения на репрезентативном клиническом материале. Introduction. The need for the treatment of diabetes mellitus (DM) ophthalmic complications remains high due to the steady increase in the number of patients. Forms of diabetic macular edema (DME) associated with the presence of the vitreomacular interface anomalies (VMIA) require a differentiated approach to the management and vitreoretinal surgery technique. Purpose. To demonstrate the possibilities of method of the dosed fovea-sparing peeling of the retinal internal limiting membrane (DFSP ILM) in the DME treatment. Materials and methods. Two clinical observations are presented – cases of VMIA-DME treatment using the DFSP ILM method. In both cases, the patients underwent combined treatment: cataract phacoemulsification with intraocular lens implantation in combination with vitrectomy (VRS) with DFSP ILM peeling. The postoperative follow-up period was 12 months. Results. During the dynamic observation in the first 3–6 months after treatment, positive anatomical and functional results were noted. By the 6th month, the development of DME was detected in both cases, which required the use of anti-VEGF therapy. In case 1, by the 12th month of observation, anatomical improvement was noted, but due to the formation of hard exudate in the fovea centralis area, visual acuity was lower than the initial one. In case 2, against the background of treatment, a slow positive dynamics of DME was noted with the preservation of visual function at the postoperative level. In both cases, intra- and postoperative complications of DFSP ILM peeling were not observed, such as the formation of iatrogenic retinal tears, detachment of the neuroepithelium, and the development of postoperative epimacular membrane. Conclusion. DFSP ILM is an example of a fovea centralis protection method during VRS. These technologies are promising, however, they require study on representative clinical material.

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Section:  обсуждениеunclassified

Dosed Fovea-Sparing Internal Limiting Membrane Peeling in Diabetic Macular Edema Treatment (Clinical Observations)

Филиппов¹,

Петрачков²,

Барышев³

2023

Офтальмология. Восточная Европа

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“…Данный метод был предложен в 2010 г. J. Nawrocki и Z. Michalewska [12]. В последующем данный способ неоднократно совершенствовался, и к настоящему моменту метод имеет большое количество различных модификаций [13][14][15]. Для лечения СМР также используют различные биоадгезивные вещества, получаемые из аутоплазмы, что позволяет минимизировать интраоперационную травму, улучшить анатомические и функциональные результаты операции, особенно при СМР большого диаметра [16,17].…”

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Comparison of Early Treatment Outcomes for Large Macular Hole Using Various Surgical Techniques

Petrachkov¹,

Alkharki²,

Matyushchenko³

et al. 2021

Oftalʹmologiâ

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Macular hole (MH) is one of the most common pathologies of the macular area of the retina which leads to a significant decrease in visual acuity. The article presents early comparative morphofunctional results of surgical treatment of 60 patients (22 men and 38 women) with MH of the III–IV stages according to Gass and the minimum diameter (MinD) MH 404–696 microns. All patients included in the study had pseudophakia and have not previously undergone endovitreal interventions. Patients with MH with a diameter of 404–696 μm were randomized and divided into 3 equal groups: after three-port 25G pars plana posterior vitrectomy the patients of the first group underwent peeling of the inner limited membrane (ILM) with the convergence of the edges of MH and vitreous cavity tamponade with 16 % gas-air mixture of perfluoropropane (C2F6). In the area of the macular defect, patients of the second group underwent application of autologous conditioned plasma (ACP) in the PFСs environment and the convergence of the edges of MH. In patients of the third group, MH was closed using the technique of an inverted ILM flap. In patients of groups 2 and 3 the operation was completed by tamponade of the vitreous cavity with sterile air. Standard and special research methods, such as optical coherence tomography of the macular zone, were performed before surgery, 5 days and 1 month after surgery in all patients from groups 2 and 3. Patients from group 1 were examined before surgery and 1 month after surgical treatment, due to the long-lasting gas-air mixture in the vitreous cavity. Restoration of the correct structure of the fovea with the formation of U- and V-shaped profile during OCT after 1 month was noted in all cases. The data obtained demonstrate the peculiarities of using the inverted ILM flap and ACP methods in comparison with the traditional method of MH closure with a gas-air mixture.

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Changes of the morpho-functional parameters of the retina of patients after surgical treatment of rhegmatogenous retinal detachment complicated by macular hole in the early postoperative period

Fayzrakhmanov,

Vaganova,

Sekhina

et al. 2023

Saratov J Med Sci Res

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Objective: to realize the effectiveness of surgical treatment of patients with retinal detachment and macular hole PVR C, depending on the method of closing the macular hole. Material and methods. The data of 20 patients (20 eyes) with a diagnosis of retinal detachment with macular hole PVR С were studied. Patients of the 1st group (10 patients, 10 eyes) underwent surgical treatment with closure of the macular hole with an inverted flap of the inner limiting membrane. Patients of the 2nd group (10 patients, 10 eyes) did not undergo closure of the macular hole during the first stage of surgical treatment. Results. In the 1st group, it was possible to achieve closure of the macular hole in 80% of cases. In the 2nd group, a day after the operation, there was a significant decrease in the diameter to 263±46 urn. When re-examined a month later, in 80% of cases, the macular hole was closed. When studying the results of micro-perimetry one day after the operation, positive dynamics was noted. While after a month of observation, the indicators of patients in the second group were significantly higher. Conclusion. The method of surgical treatment of retinal detachment with macular hole showed greater efficiency in refusing to perform membranopiling; in patients of this group, higher functional results were achieved. During the observation period, cases of a decrease in the diameter of an intact macular hole and its complete closure under the action of silicone tamponade were recorded. If necessary, membrane peeling can be delayed during a second silicone oil removal operation.

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The method of closing macular holes with partial preservation of the internal limiting membrane

Cited by 10 publications

References 4 publications

Dosed Fovea-Sparing Internal Limiting Membrane Peeling in Diabetic Macular Edema Treatment (Clinical Observations)

Dosed Fovea-Sparing Internal Limiting Membrane Peeling in Diabetic Macular Edema Treatment (Clinical Observations)

Comparison of Early Treatment Outcomes for Large Macular Hole Using Various Surgical Techniques

Changes of the morpho-functional parameters of the retina of patients after surgical treatment of rhegmatogenous retinal detachment complicated by macular hole in the early postoperative period

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