Comparative analysis of the effectiveness of large macular hole surgery by re-approximation of the hole edges after internal limiting membrane peeling using various techniques

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

BACKGROUND: Idiopathic macular hole is an acquired condition which decreases central vision. Its size and duration are the factors to be considered in macular holy surgery. As the data on the effectiveness of various surgical techniques of macular hole closure are inconsistent, this issue is relevant and warrants a study.

AIM: The study aimed to analyze the effectiveness of large macular hole surgery by re-approximation of the hole edges after internal limiting membrane peeling using various techniques.

METHODS: The clinical data are based on the results of an examination of 60 patients with stage III–IV idiopathic macular holes (60 eyes). The initial hole diameter ranged from 404 to 907 µm, the mean diameter was 575 ± 63 µm. Best corrected visual acuity ranged from 0.02 to 0.2. The study included three groups of 20 patients each. The groups were divided based on the surgical technique of macular hole closure. Air was used for tamponade in group 1, light silicone oil (5700 cSt) was used in group 2, and group 3 underwent sterile air tamponade with application of up to 0.1 mL of autologous conditioned plasma to the macular hole area.

RESULTS: Macular hole closure was achieved in 16 out of 20 patients of group 1. One year examination results showed increased best corrected visual acuity in all patients, which ranged from 0.04 to 0.7 (mean: 0.34 ± 0.18). In group 2, macular holes were closed in 95% of cases (19 patients). At one year, best corrected visual acuity increased in all patients and ranged from 0.03 to 0.6 (mean: 0.32 ± 0.16). In group 3, primary surgery resulted in macular hole closure in 19 (95%) patients. At one year, they showed an additional improvement of best corrected visual acuity, which ranged from 0.04 to 0.8, with mean best corrected visual acuity of 0.38 ± 0.12.

CONCLUSION: Analysis of the results of large macular hole surgery showed a relatively similar closure rate, which was 95% with autologous conditioned plasma, 95% with silicone oil tamponade, and 80% with sterile air tamponade. Silicone oil tamponade may be used for patients who cannot position facedown after surgery. The disadvantages of silicone oil tamponade include the need for repeated surgery.

About the authors

Albert V. Zhigulin

S. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk branch

Author for correspondence.
Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0001-7929-2007
SPIN-code: 2698-3164

MD

Russian Federation, Khabarovsk

Nikolay V. Mashchenko

S. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk branch

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0002-2200-2221
SPIN-code: 1033-0646

MD

Russian Federation, Khabarovsk

Evgenii L. Sorokin

S. Fyodorov Eye Microsurgery Federal State Institution, the Khabarovsk branch; Far-Eastern State Medical University

Email: naukakhvmntk@mail.ru
ORCID iD: 0000-0002-2028-1140
SPIN-code: 4516-1429

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Khabarovsk; Khabarovsk

References

  1. Avakyan FA. Surgical treatment of idiopathic macular hole with preservation of the foveal internal limiting membrane [dissertation]. Moscow; 2024. 114 p. (In Russ.)
  2. Kirchhof B, Wong D. Vitreo-retinal surgery. Springer; 2007. 177 p. doi: 10.1007/978-3-540-33670-9
  3. Ittarat M, Somkijrungroj T, Chansangpetch S, Pongsachareonnont P. Literature review of surgical treatment in idiopathic full-thickness macular hole. Clin Ophthalmol. 2020;14:2171–2183. doi: 10.2147/OPTH.S262877
  4. Li JQ, Hattenbach L-O, Lommatzsch A, et al. Macular hole: Differential diagnosis, treatment options and new guideline recommendations. Ophthalmologie. 2024;121(6):462–469. doi: 10.1007/s00347-024-02047-z
  5. Podgorny AI, Barkova NYu, Kosheleva AA, et al. Efficiency of gas-air and air tamponade during surgery for idiopathic macular holes. Modern technologies in ophthalmology. 2016;(1):186–187. EDN: WEGZXJ (In Russ.)
  6. Goldbaum MH, McCuen BW, Hanneken AM, et al. Silicone oil tamponade to seal macular holes without position restrictions. Ophthalmology. 1998;105(11):2140–2147. doi: 10.1016/S0161-6420(98)91140-X
  7. Zakharov VD, Kislitsyna NM, Kolesnik SV, et al. Modern approaches to surgical treatment of full-thickness large idiopathic macular holes (literature review). Practical medicine. 2018;(3):64–70. EDN: YXORZW
  8. Samoilov AN, Khaybrakhmanov TR, Fazleeva GA. Comparative analysis of the results of surgical treatment of idiopatic makular breaks of a large diameter depending on the method of the tamponade of the vitreal cavity. International student scientific bulletin. 2017;(4–7):993–995. EDN: ZFTPAZ
  9. Gaudric A, Massin P, Paques M, et al. Autologous platelet concentrate for the treatment of full-thickness macular holes. Graefes Arch Clin Exp Ophthalmol. 1995;233(9):549–554. doi: 10.1007/BF00404704
  10. Laskova IV, Kravchenko AA, Uskov DI, Svitko NG. The use of autologous conditioned plasma in combination with hydrodissection of chorioretinal connections in the surgical treatment of large full-thikness macular holes. Modern technologies in ophthalmology. 2020;(1):190192. doi: 10.25276/2312-4911-2020-2-190-193 EDN: NIDUZK
  11. Fayzrahmanov RR, Krupina EA, Pavlovskiy OA, et al. Analysis of platelet-rich plasma obtained in various ways. Medline.ru. 2019;20(2):363–372. EDN: AEKHLG
  12. Zakharov VD, Shkvorchenko DO, Krupina EA, et al. Long-term results in surgery of idiopathic macular holes with platelet-rich plasma. Tavrichesky medical and biological bulletin. 2018;21(3):35–38. EDN: YUKPCP
  13. Kulikov AN, Churashov SV, Popov EM. Methods of treatment of macular hole: history and prospects. Bulletin of Pirogov National Medical And Surgical Center. 2021;16(1):135–138. doi: 10.25881/BPNMSC.2021.14.53.026 EDN: FEWHBW
  14. Shkvorchenko DO, Zakharov VD, Krupina EA, et al. Surgical treatment of primary macular hole using platelet-rich plasma. Fyodorov journal of ophthalmic surgery. 2017;(3):27–30. EDN: ZQLJIF
  15. Samoylov AN, Khaibrakhmanov TR, Fazleeva GA, Samoylova PA. Idiopathic macular hole: history and status quo review. Russian annals of ophthalmology. 2017;133(6):131–137. doi: 10.17116/oftalma20171336131=137 EDN: YLJHAF
  16. Shamratov RZ, Ramazanova LSh, Napylova OA, et al. Years of experience in the use of autologous conditioned blood plasma for macular holes. Caspian herald of medicine and pharmacy. 2024;5(2):45–51. doi: 10.17021/2712-8164-2024-45-51 EDN: OVEMPO
  17. Demchenko NS, Kleymenov AYu, Kazaykin VN. Biological effects of platelet-rich plasma in the treatment of macular holes. Reflection. 2023;(1):26–35. doi: 10.25276/2686-6986-2023-1-26-35 EDN: ELBXQZ
  18. Eckardt C, Eckardt U, Groos S, et al. Removal of the internal limiting membrane in macular holes. Clinical and morphological findings. Ophthalmologe. 1997;94(8):545–551. (In German) doi: 10.1007/s003470050156
  19. Rizzo S, Tartaro R, Barca F, et al. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38(S1): S73–S78. doi: 10.1097/IAE.0000000000001985
  20. Morescalchi F, Costagliola C, Gambicorti E, et al. Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol. 2017;62(1):58–69. doi: 10.1016/j.survophthal.2016.07.003
  21. Shin MK, Park KH, Park SW, et al. Perfluoro-n-octaneassisted single-layered inverted internal limiting membrane flap technique for macular hole surgery. Retina. 2014;34(9):1905–1910. doi: 10.1097/IAE.0000000000000339
  22. Bayborodov YaV. Anatomical and functional results of using various surgical techniques for closing macular holes. Modern technologies in ophthalmology. 2015;(1):22–24. EDN: TUHPBH (In Russ.)
  23. Zeng M, Cai C, Chen X. Comparing the inverted internal limiting membrane flap technique with internal limiting membrane insertion technique for treatment of large macular holes. Retina. 2025;45(7):1353–1359. doi: 10.1097/IAE.0000000000004443
  24. Belyi IA, Tereshchenko AV, Shkvorchenko DO, et al. A new technique of inverted internal limiting membrane flap formation in a surgical treatment for large idiopathic macular holes. Ophthalmology in Russia. 2015;12(4):27–31. doi: 10.18008/1816-5095-2015-4-27-33 EDN: VBCWSF
  25. Petrachkov DV, Zamytsky PA, Zolotarev AV. The role of approximation of the edges of a through-and-through macular hole when using the inverted flap technique. Modern technologies in ophthalmology. 2017;(1):221–225. EDN: YLJUJB (In Russ.)
  26. Braziticos PD, Katsimprs JM, Tsironi E, Androudy S. Retinal nerve fiber layer thickness evaluation after trypan blue- assisted macular surgery. Retina. 2010;30(4):640–647. doi: 10.1097/IAE.0b013e3181c085ab
  27. Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et al. Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina. 2015;35(9):1844–1850. doi: 10.1097/IAE.0000000000000555
  28. Andrew N, Chan WO, Tan M, et al. Modification of the inverted internal limiting membrane flap technique for the treatment of chronic and large macular holes. Retina. 2016;36(4):834–837. doi: 10.1097/IAE.0000000000000931
  29. Shandurkov I, Vassileva P. Inverted internal limiting membrane peeling technique with silicone oil tamponade for repair of recurrent large macular holes in vitrectomized diabetic patients. Scripta Scientifica Medica. 2014;46(4):25–30. doi: 10.14748/ssm.v46i4.1016
  30. Petrachkov DV, Alkharki L, Matyushchenko AG, et al. Comparison of early treatment outcomes for large macular hole using various surgical techniques. Ophthalmology in Russia. 2021;18(3S):681–687. doi: 10.18008/1816-5095-2021-3S-681-687 EDN: PVSPIO
  31. Shpak AA, Avakyan FA, Kolesnik AI. Clinical and functional results of idiopathic macular holes treatment with foveal internal limiting membrane sparing. Fyodorov journal of ophthalmic surgery. 2023;(3):78–85. doi: 10.25276/0235-4160-2023-3-78-85 EDN: OUTCRD
  32. Shpak AA, Shkvorchenko DO, Sharafetdinov IKh, Yukhanova OA. Functional outcomes of idiopathic macular hole surgeries. Russian annals of ophthalmology. 2016;132(2):14–20. doi: 10.17116/oftalma2016132214-20 EDN: VTIJNT
  33. Shpak AA, Shkvorchenko DO, Sharafetdinov IKh, Yuhanova OA. Predicting the results of surgical treatment of idiopathic macular hole. Fyodorov journal of ophthalmic surgery. 2015;(2):55–61. EDN: UDSNHX
  34. Bikbov MM, Zainullin RM, Gilmanshin TR, et al. The results of large macular hole surgery using Autologous conditioned plasma. Point of view. East – West. 2020;(2):33–35. doi: 10.25276/2410-1257-2020-2-33-35 EDN: MWGBNI
  35. Bikbov MM, Altynbayev UR, Gilmanshin TR, Chernov MS. Selecting the method of intraoperative closing of large idiopathic macular hole. Fyodorov journal of ophthalmic surgery. 2010;(1):25–28. EDN: PXQZPF
  36. Krupina EA. Surgical treatment of idiopathic macular hole using platelet-rich plasma [dissertation]. Moscow; 2019. 119 p. EDN: ROVDTU (In Russ.)
  37. Putienko AA. Results of vitreous surgery of macular holes with a diameter over 800 µm using a 20% gas-air mixture of perfluoropropane. Ophthalmological Journal. 2019;(2):33–37. (In Russ.) EDN: ZSNTBZ
  38. Podgorny AI, Barkova NYu, Kosheleva AA, et al. Efficiency of gas-air and air tamponade during surgery for idiopathic macular holes. Modern technologies in ophthalmology. 2016;(1):186–187. (In Russ.) EDN: WEGZXJ
  39. Belyi YuA, Tereshchenko AV, Shilov NM., Erokhina EV. Technique of internal limiting membrane surgery in the treatment of large idiopathic macular holes. Point of view. East – West. 2015;(1):125–127. (In Russ.) EDN: UIBNGL
  40. Shilov NM, Tereshchenko AV, Yudina NN, et al. Technology of inverted flap of internal limiting membrane in surgery of primary penetrating macular retinal holes. Literature review. Ophthalmologia. 2025;22(2):265–272. (In Russ.) doi: 10.18008/1816-5095-2025-2-265-272 EDN: CERQLZ
  41. Demchenko NS, Kleymenov AYu, Kazaikin VN. Mechanisms of the therapeutic effect of platelet-rich plasma in macular hole surgery. Russian Ophthalmological Journal. 2023;16(1):22–28. doi: 10.21516/2072-0076-2023-16-1-22-28 EDN: MGLKGL

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2025 Eco-Vector

License URL: https://eco-vector.com/for_authors.php#07
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).