[Surgical treatment of full-thickness macular holes with proliferative epiretinal structures (preliminary results)].

Abstract

Purpose: This study aimed to develop a surgical technique for the treatment of full-thickness macular holes (MH) with proliferative epiretinal structures (epiretinal membrane (ERM) with or without epiretinal proliferation), and to assess its clinical efficacy.

Material and methods: The study included 34 patients (34 eyes) with secondary MH of small and medium diameter (minimum diameter ≤400 µm) with ERM structures. The main group consisted of 16 patients (16 eyes) who underwent surgical treatment using the developed technique of inverted internal limiting membrane (ILM)/ERM flap, preserving an intact retinal zone 0.5 mm wide concentrically around the MH. The control group included 18 patients (18 eyes) who underwent surgery using the peeling technique, classic circular maculorrhexis, and tamponade of the vitreous cavity with a gas-air mixture (SF6).

Results: Postoperatively in all patients of the main group the edges of the hole were aligned with a preserved local hyporeflective area in the ellipsoid zone of the photoreceptors, and its size gradually decreased with the course of the follow-up (3, 6, and 12 months). The macular hole remained unclosed in two patients from the control group. In the main group there was a statistically significant increase in the mean best-corrected visual acuity (BCVA) from 0.19±0.11 preoperatively to 0.57±0.21 by the end of the follow-up (p<0.05). The improvement in BCVA in the main group was more pronounced compared to the control group (p<0.05). The main group also showed a gradual increase in central retinal sensitivity at all follow-up points. The control group exhibited similar changes, but the increase in central retinal sensitivity was less significant compared to the main group (p<0.05).

Conclusion: The proposed surgical technique allows achieving high anatomical and functional outcomes without prolonged vitreous cavity tamponade by removing all ERMs that create tangential traction at the edges of the hole, and peeling of the ILM, which serves as a substrate for the subsequent development of epiretinal fibrosis. Additionally, it delicately preserves the proliferative epiretinal tissue at the hole's edge and the retinal structures, establishing the long-term functional outcome of surgical treatment.