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

Shilov N.M.; Tereshchenko A.V.; Erokhina E.V.; Plakhotniy M.A.; Novikov S.V.

doi:https://doi.org/10.17116/oftalma202414005146

Shilov N.M.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0002-2392-3049

Tereshchenko A.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”;
Medical Institute of the Tsiolkovsky Kaluga State University

ORCID: 0000-0002-0840-2675

Erokhina E.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0001-7320-9209

Plakhotniy M.A.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0002-4099-819X

Novikov S.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0003-4953-4663

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

Authors:

Shilov N.M., Tereshchenko A.V., Erokhina E.V., Plakhotniy M.A., Novikov S.V.

More about the authors

Journal: Russian Annals of Ophthalmology. 2024;140(5): 46‑55

DOI: 10.17116/oftalma202414005146

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To cite this article:

Shilov NM, Tereshchenko AV, Erokhina EV, Plakhotniy MA, Novikov SV. Surgical treatment of full-thickness macular holes with proliferative epiretinal structures (preliminary results). Russian Annals of Ophthalmology. 2024;140(5):46‑55. (In Russ.)
https://doi.org/10.17116/oftalma202414005146

Подписка 2026 Вестник офтальмологии (Russian Annals of Ophthalmology)

Использование инфографики авторами научных работ

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.

Keywords:

full-thickness macular hole

proliferative epiretinal structure

epiretinal membrane

epiretinal proliferation

Authors:

Shilov N.M.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0002-2392-3049

Tereshchenko A.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”;
Medical Institute of the Tsiolkovsky Kaluga State University

ORCID: 0000-0002-0840-2675

Erokhina E.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0001-7320-9209

Plakhotniy M.A.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0002-4099-819X

Novikov S.V.

Kaluga branch of the S.N. Fedorov National Medical Research Centre “MNTK “Eye Microsurgery”

ORCID: 0000-0003-4953-4663

Received:

15.02.2024

Accepted:

22.05.2024

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References:

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