ABSTRACT
The issue of indications for surgical treatment of lamellar macular holes (LMH) remains debatable, especially considering the different opinions about the possibility of their progression. PURPOSE: To study natural course of LMH and to develop criteria of their progression. MATERIAL AND METHODS: The study analyses retrospective data of patients with LMH observed in S. Fyodorov Eye Microsurgery Federal State Institution from 2013 to 2018 who were examined by optical coherence tomography (OCT) at least 2 times with an interval between the initial and last examinations of at least 6 months. The examinations were carried out to evaluate the types of LMH and epiretinal membrane, the ellipsoid zone of photoreceptors and vitreoretinal interface, as well as calculate the changes in the quantitative parameters of the LMH. RESULTS: One hundred and three patients with LMH were identified; data of 65 patients (65 eyes) was studied in detail. The follow-up lasted 20.5±12.9 months on average. Statistically substantiated criteria for the progression of tractional and degenerative LMH were developed, taking into account the OCT changes most significant for each type of LMH. According to the proposed criteria, signs of marked progression were found in 2 (5.3%) of 38 patients with tractional and 4 (14.8%) of 27 patients with degenerative LMH. Moderate progression was detected in 2 (5.3%) patients with tractional and 2 (7.4%) patients with degenerative LMH. In two patients who were not included in the groups for calculating the criteria for progression, the formation of a full-thickness macular hole has occurred. CONCLUSION: One of the variants of the natural course of LMH can be its progression up to transition into a full-thickness macular hole. The proposed statistically substantiated criteria allows identifying dangerous progression of LMH, which should be taken into account when determining the treatment tactics.
Subject(s)
Epiretinal Membrane , Retinal Perforations , Follow-Up Studies , Humans , Retrospective Studies , Tomography, Optical Coherence , Visual AcuityABSTRACT
PURPOSE: To present a two-port endovitreal surgery technique without endoillumination as a method of choice for sparing surgery of the macular area. MATERIAL AND METHODS: Study group included 16 patients (16 eyes) with cataract and macular pathology (8 - with a macular hole (MH) and 8 - with epiretinal fibrosis). Preoperative mean best corrected visual acuity (BCVA) was 0.15±0.10. The maximum follow-up period lasted 6 months. All surgeries were performed by the same specialist using surgical microscope OMS-800™ ('Topcon') fitted with visualization system OFFISS (Optical Fiber-free Intravitreal Surgery System) and 3D visualization system NGENUITY (Alcon). In each case, cataract phacoemulsification with IOL implantation was performed prior to two-port 25-27G pars plana vitrectomy. One port was used for placing the irrigation cannula, the other - for injection of various tools. The light of the microscope tube was used for illumination. Light and color parameters were set up using Alcon NGENUITY 3D visualization system for the microscope light to be used at minimal required intensity that achieved adequate, clear image. RESULTS: The two-port surgery was successfully performed in all 16 patients of the study group. Neither intraoperative nor postoperative complications were observed. There was no rise or decrease in intraocular pressure (IOP) within the specified follow-up period. In the postoperative period, anatomical results were evaluated by optical coherent tomography (OCT). The hole was blocked successfully in all cases, and the epiretinal membrane (ERM) could not be determined. Mean BCVA increased to 0.5±0.3. CONCLUSION: The technique of two-port surgery without endoillumination allows safe and effective surgical treatment of the macular pathology.
