V.D. ZAKHAROV¹, N.M. KISLITSYNA¹, S.V. NOVIKOV², S.V. KOLESNIK¹, A.I. KOLESNIK¹, M.P. VESELKOVA¹

¹The S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky 59a blvr, Moscow, Russian Federation, 127486

²Scientific-experimental Production “Eye Microsurgery”, Beskudnikovsky 59a blvr, building B, Moscow, Russian Federation, 127486

 Zakharov V.D. – Doc. Med. Sc., Professor, Head of the Vitreoretinal Surgery and Eye Diabetes Department, tel. (499) 488-85-53, e-mail: info@mntk.ru

Kislitsyna N.M. – Cand. Med. Sc., ophthalmosurgeon of the Vitreoretinal Surgery and Eye Diabetes Department, tel. +7-905-515-35-78, e-mail: natalikislitsin@yandex.ru

Novikov S.V. – Deputy Director General, tel. (499) 488-85-75, e-mail: snovikov@yandex.ru

Kolesnik S.V. – Cand. Med. Sc., Researcher of the Vitreoretinal Surgery and Eye Diabetes Department, tel. (495) 488-87-17, e-mail: svkolesnik83@gmail.com

Kolesnik A.I. – Cand. Med. Sc., Researcher of the Vitreoretinal Surgery and Eye Diabetes Department, tel. (495) 488-89-20 e-mail: doc_ant@mail.ru

Veselkova M.P. – postgraduate student of the Vitreoretinal Surgery and Eye Diabetes Department, tel. +7-906-771-20-45, e-mail: veselkova.mp@gmail.com

In the article we analyze the results of surgical treatment of idiopathic macular holes (IMH) of large diameter using the “inverted flap” technique in various modifications, using a “Vitreocontrast” suspension based on barium sulphate as a contrast agent. We examined 65 people (65 eyes) with IMH with a follow-up period of 12 months after surgical treatment. The patients were divided into 2 groups; the patients of group 1 (35 eyes) underwent a microinvasive subtotal vitrectomy, internal limiting membrane staining (ILM) with “Vitreocontrast” suspension, circular ILM peeling and putting of the ILM leafs onto a rupture according to the classical “inverted ILM flap” technique. In group 2 (30 eyes), according to the modified technology, after ILM peeling, the excess of the ILM fragment was removed and a single ILM leaf was placed onto the rupture. In both groups, the operation was completed with an air tamponade. At follow up periods of 1, 3, 6 and 12 months after the intervention, standard ophthalmological examination, as well as optical coherence tomography (OCT), microperimetry and fundus photoregistration were performed. Analysis of the treatment results showed that both classical technique of the “inverted flap” with the use of the Vitreocontrast suspension as a contrast agent, and the modified method with the placement of a single ILM leaf on the rupture area lead to anatomical closure in almost all cases and a significant increase in visual acuity. With the use of the modified technique, a glial foveal scar is formed in a smaller number of cases, and in the outcomes of surgery, the closure types U, V with restoration of the histoarchitecture of the outer retina layers predominate, which are the closest to normal retinal anatomy and are associated with the highest functional prognosis, which allows recommending application of the proposed technique.

Key words: macular rupture, optical coherence tomography, internal limiting membrane, chromovitrectomy, “Vitreocontrast”.

(For citation: Zakharov V.D., Kislitsyna N.M., Novikov S.V., Kolesnik S.V., Kolesnik A.I., Veselkova M.P. Surgical treatment of large macular holes by various modifications of the “inverted flap” technique using original suspension “Vitreocontrast” as a contrast agent. Practical Medicine. 2018)

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