[Long-term outcomes of treating rhegmatogenous retinal detachment with macular hole using platelet-rich blood plasma]. / Otdalennye rezul'taty khirurgicheskogo lecheniya regmatogennoi otsloiki setchatki, oslozhnennoi makulyarnym razryvom, s ispol'zovaniem bogatoi trombotsitami plazmy krovi.

Currently there is no specific algorithm for treating rhegmatogenous retinal detachment complicated by macular hole. PURPOSE: The study analyzed the long-term outcomes of surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by macular hole (MH) using platelet-rich plasma (PRP) and local staining of the internal limiting membrane (ILM). MATERIAL AND METHODS: This prospective open-label study included 27 patients (15 females and 12 males) aged 57 to 65 (59.2±7.2) years. In all studied cases, RRD complicated by MH was determined. The best corrected visual acuity (BCVA) before surgery was 0.05±0.01 (from 0.02 to 0.08). The average MH diameter measured with OCT was 576.3±150.4 µm (409 µm to 944 µm). After vitrectomy, a perfluororganic compound (PFOC) was injected into the MH area in amount of 2-3 optic nerve head diameters to prevent the ingress of dye under the retina, then the internal limiting membrane (ILM) was stained and removed. After sequential PFOC/air replacement, PRP was injected into the macular hole site. RESULTS AND DISCUSSION: An increase in BCVA from 0.05±0.01 to 0.09±0.03 was observed in the preoperative period one month after surgery, with a further increase to 0.35±0.11 at the maximum follow-up time (two years). The MH was blocked and a glial scar was present in all cases according to OCT data. 1-2 years after the operation, all patients showed a favorable anatomical effect according to OCT data. According to computer microperimetry data, mean macular photosensitivity was 23.8±1.3 dB two years after the surgery. CONCLUSIONS: This study shows a favorable anatomical and functional effect in patients with RRD and MH within a 2-year follow-up. A comparative study involving a larger cohort of patients is required to clarify the indications and contraindications for the use of the studied technique.

[Outcomes of surgical treatment of rhegmatogenous retinal detachment after phaco surgery and implantation of a trifocal intraocular lens in patients with myopia (clinical observations)]. / Rezul'taty khirurgicheskogo lecheniya regmatogennoi otsloiki setchatki posle fakokhirurgii i implantatsii trifokal'noi intraokulyarnoi linzy pri miopii (klinicheskie nablyudeniya).

PURPOSE: To analyze visual functions in moderate and high myopic patients with retinal detachment that developed after implantation of a trifocal intraocular lens (IOL). MATERIAL AND METHODS: The study analyzed the functional outcomes achieved in 3 patients (4 eyes) with retinal detachment developed after implantation of AcrySof IQ PanOptix («Alcon¼, USA) and AT LISA tri 839 MP («Carl Zeiss Meditec¼, Germany) during the follow-up period of 24 months. Patient examination included measurements of visual acuity at far (4 and 5 m), near (40 cm) and intermediate distances (60 cm, 80 cm), spatial contrast sensitivity, spherical equivalent of refraction, and a survey of patients for subjective satisfaction of the obtained vision. RESULTS: In four eyes of three patients with moderate and high myopia, rhegmatogenous retinal detachment was diagnosed during the follow-up period at 4 to 12 months after phacoemulsification of cataract with trifocal IOL implantation. The best visual indicators were found in patient N. as a result of surgical treatment of bilateral rhegmatogenous retinal detachment due to high myopia: visual acuity (VA) at far distance was 1.0 for each eye (with 100 points on the VF-14 questionnaire). In patients P. and M., after the development of unilateral rhegmatogenous retinal detachment, complete retinal reattachment was achieved after surgery with VA at far distance 0.55 (OS) in patient P. and 0.4 (OD) in patient M. (95 and 86 points on VF-14, respectively). CONCLUSION: Good visual functions were achieved in three patients with trifocal IOL after surgical treatment of the rhegmatogenous retinal detachment that developed due to myopia. The implanted trifocal IOL did not affect the effectiveness of vitrectomy. After the treatment patients retained the ability to see at different distances.

[Natural course of lamellar macular holes]. / Estestvennoe techenie lamellyarnykh makulyarnykh razryvov.

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.

[Two-port pars plana vitreomacular surgery without endoillumination]. / Dvukhportovaia vitreomakuliarnaia khirurgiia bez ispol'zovaniia éndoosvetitelia.

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.

[Functional outcomes of idiopathic macular hole surgeries].

AIM: To study the dynamics of visual status and its correlation with morphological changes in patients operated for idiopathic macular hole (IMH). MATERIAL AND METHODS: The study enrolled 78 patients (82 eyes) whose ocular media remained transparent throughout the whole follow-up period that started 1 month after a successful IMH surgery and lasted for no less than a year. Two equivalent subgroups, 29 patients (30 eyes) each, were then formed and designated as «transparent media¼ (pseudophakic patients or those who remained free of cataract over the follow-up period) and «comparison¼. RESULTS: Only patients from the «transparent media¼ subgroup have consistently improved their visual functions by the end of the first year after surgery. Positive correlation has been found between an increase in best corrected visual acuity (BCVA) and a decrease in the size of the hyporeflective defect within the so called ellipsoid zone (correlation coefficient r=-0.50, p<0.01). The correlation was the strongest at months 3 and 12 (r=-0.57, p<0.01). It was also noticed that the lower BCVA at baseline the greater the treatment effect (ETDRS chart; r=-0.93, p<0.000). As a result, at the end of the follow-up period, BCVA varied little, reaching 0.5--1.0 in 76 cases and 0.3--0.4 in the remaining 6 cases. CONCLUSION: Modern IMH surgery ensures restoration of the outer retinal structure and high visual functions in most patients over a long term (more than a year of follow-up) on the only condition of transparent ocular media. Thus, the prediction of postoperative VA is of low significance in these patients.

[Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes]. / Metodika poetapnogo formirovaniya fragmenta vnutrennei pogranichnoi membrany v khirurgicheskom lechenii bol'shikh idiopaticheskikh makulyarnykh otverstii.

AIM: to develop a surgical procedure for large idiopathic macular holes (MH) that would involve creation of an original internal limiting membrane (ILM) flap to close the hole with. MATERIAL AND METHODS: Nineteen patients aged from 59 to 71 years with stage 3 idiopathic MH (by J. Gass) were enrolled. Besides standard ophthalmic examination, spectral optical coherence tomography and microperimetry were performed in all cases. The patients were followed up 2 weeks and then 1 and 3 months after surgery. Surgical procedure was notable for an original ILM flap created in a way that resembles removing petals from a flower. The new method implies that the ILM is peeled off all the way round the MH except for the foveolar area and one particular ILM fragment, which is only partially separated from the retina, from the periphery towards the MH, stopping at some 0.1-0.2 mm from its margin. This last fragment is then inverted to cover the MH. RESULTS: All surgeries were completed without complications. Visual acuity has gradually increased over the follow-up period in all patients: from 0.1-0.4 to 0.3-0.7 (0.39±0.15 on the average; Sivtsev-Golovin chart). Foveal anatomy has also improved: complete closure of the MH was achieved in 8 patients, partial - in 11. Moreover, all patients demonstrated a shift of the retinal fixation point towards the center of the fovea for 153-369 mm, at that, their fixation has stabilized and absolute central scotomas disappeared. CONCLUSION: The method developed is a promising treatment for large idiopathic macular holes. Further studies are required.

[Sympathetic ophthalmia. Clinical and morphological study in 6 cases after penetrating injury and subsequent repeated vitreoretinal operations].

The paper outlines the clinical and morphological picture of 6 sympathizing eyes enucleated in 1996 to 2003 after vitrectomy and other endovitreal interventions into early injured or operated eyes. Resurgery was attempted early after wounds or a primary operation on the average following 20 days. Sympathetic ophthalmia (SO) generally occurred in the posterior uveal tract as panuveitis or posterior uveitis and diagnosed in the late periods. Specific granulomatous inflammation in the uveal tract was observed in all eyes and the morphological feature of sympathizing eyes was the spread of an inflammatory process to the retina with the development of the latter's epithelioid-cell granulomas and adhesive chorioretinitis. The authors also discuss the possibility of additional antigenic stimulation accompanied by a progressive autoimmune process in the eye and by the generalization of a granulomatous inflammation, as well as the role of retinal minor lesions in this process as a source of additional autoantigens during repeated vitreoretinal operations. The latter, as the authors believe, are a risk factor of SO. In this connection, when repeated vutreoretinal interventions should be made in the presence of an uncompleted wound process in the eye and when they should be conducted under the conditions of active immunosuppressive therapy gain in great importance.