Comparative efficacy of surgical treatment of macular holes with the use of platelet-rich plasma

Purpose. Evaluation of the results of treatment of idiopathic macular holes (MH) with the use of autologous platelet-rich plasma (PRP) in comparison with standard technology in terms of up to 12 months.Material and methods. We examined 62 people (66 eyes) with MH, operated by two highly skilled surgeons, with application of PRP on the MH (the main group). The control group consisted of 165 patients (173 eyes) operated by the same surgeons in 2010-14 by standard technology.Results. The compared groups did not differ in age-sex characteristics, axial length of the eye, hole duration. Parameters of the MH and foveal region were significantly worse in the main group compared to the control group; in particular, the minimum diameter of the hole was 445±184 μm vs. 376±149 μm. Despite this, the anatomical and functional results of the treatment in the main group were significantly better than in the control group. In all patients of the main group, it was possible to achieve complete closure of the hole, while in the control group the hole was not blocked in 14 eyes (P=0.013). Measured 12 months after surgery, the median increase in visual acuity was almost 9 ETDRS letters greater in the main group (P=0.012).Conclusion. The use of PRP significantly improves the anatomical and functional results of treatment of idiopathic MH, including MH of large diameter and with an unfa vorable prognosis for standard surgery

Structural changes in the macular area after surgical treatment of macular holes with the use of a platelet-rich plasma

Purpose. Evaluation of structural changes in the macular area after surgical treatment of idiopathic macular holes (MH) with the use of autologous platelet-rich plasma (PRP) in terms up to 12 months.Material and methods. We examined 41 persons (45 eyes) with idiopathic MH; patients were under observation at least 12 (up to 24) months after surgery with application of PRP to MH region. Twelve eyes with a minimum diameter of MH of at least 440 µm were allocated to the subgroup «≥440 µm». For it the control group was formed of 19 patients (19 eyes) with MH of similar sizes, successfully operated earlier by standard technology. Optical coherence tomography (OCT) and other examinations were performed at 1, 3, 6 and 12 months after operation.Results. One month after the operation with the use of a PRP, OCT demonstrated in the region of the MH an area of increased optical density and a defect of the ellipsoid zone of photoreceptors. In the eyes with a minimum diameter of MH 440 µm or more, these changes by 12 months were mostly preserved, although the defect of the ellipsoid zone was significantly reduced. In the eyes with MH less than 360µm the normal structure of the retina was restored up to 3-12 months. In the eyes with MH of 360-439 µm both variants of changes were observed. In the subgroup «≥440 µm», despite a significantly larger size of the MH, the visual functions at the end of the observation period did not differ much from the control group.Conclusion. One month after surgical treatment of MH with the use of PRP, OCT demonstrated in the region of hole the area of increased optical density and the defect of the ellipsoid zone of photoreceptors, which by 12 months decreased in size, and at MH with a minimum diameter less than 360 µm were not determined. In comparison with the standard surgical technology, the use of PRP did not have a negative impact on the functional outcome of the operation

OCT Angiography in Evaluation of the Macular Holes Treatment Results

Purpose: to assess the structure of the avascular zone and Vessel Density Retina in fovea using optical coherence tomography with angiography (OCT-angiography) after surgical treatment of macular hole, (MН) with platelet-rich plasma (PRP). Patients and methods. We examined and operated 32 patients (32 eyes) with macular hole. During surgery, after posterior hyaloid and internal limiting membrane (ILM) removing the platelet–rich plazma was appliqué on the region of the hole. Оphthalmologic diagnosis and OCT angiography were performed before and in 1 and 3 months after surgery, evaluate the area of the avascular zone and Vessel Density Retina in fovea. We compared this information with a healthy eye. Results and discussion. Аll patients had significantly visual acuity increasement. Anatomical closure was confirmed in all cases. Аfter surgery, we note a decreasement in the size of the avascular zone and increasement of the Vessel Density Retina in fovea. Conclusions. OCT angiography allows to evaluate the decreasement in the size of avascular areas and increasement of the Vessel Density Retina in fovea in postoperative period

Two-port Pars Plana surgery treatment of proliferative diabetic retinopathy without endo-illumination

Purpose. To describe and evaluate the method of surgical treatment of proliferative diabetic retinopathy  (PDR) through two port-punctures without endo-illumination.Material and methods. The study  included 10 patients  (10 eyes) with  complicated  cataract  and  PDR.  The  mean  preoperative  best corrected  visual  acuity  (BCVA)  was  0.08±0.12.  The  average  age  was 57 years: 6 males and 4  females of  them. The  follow-up period was 5 months.  All  patients  underwent  the  combined  intervention:  cataract phacoemulsification  with  intraocular  lens  implantation  and  two-port 25Gauge vitrectomy. One port was used for setting irrigation cannula, the second – for the introduction of various tools. The light of the microscope tube was used instead illumination. Light and color parameters were set up using 3D visualization system allowing using the minimal intensity of the microscope light.Results.  In 9 cases out of 10  it was possible  to apply  the claimed technique, that is, to perform the entire volume of standard manipulations, using two-port punctures. In one case, we switched to a standard three-port vitrectomy, as the patient’s rough proliferative tissue spread to the middle  periphery  and  removal  of  adhesions,  using  sclerocompression, could lead to a high risk of iatrogenic damage. Intra- and post-operative complications were not noted  in any case. The BCVA was  increased 6 months later improved and reached 0.2±0.15.Conclusion.  The  method  of  surgical  treatment  of  proliferative diabetic  retinopathy  through  two-port  punctures without  the  use  of endo-illumination  is  a  safe  and  effective  surgical  treatment  of  this disease

PREDICTING THE RESULTS OF SURGICAL TREATMENT OF IDIOPATHIC MACULAR HOLE

Purpose. To determine structural and functional parameters the most informative in predicting the anatomic effect of surgical treatment of idiopathic macular hole (IMH).Material and methods. Using the spectral-domain optical coherence tomography (SD-OCT) we examined 165 patients (173 eyes) before and after surgery for the IMH. Possible prognostic parameters were determined by the ROC-analysis and stepwise discriminant analysis in the study group (111 patients, 118 eyes) and were evaluated retrospectively in a test group (54 patients, 55 eyes).Results. The most informative prognostic indicator was the average thickness of the retina in the foveal zone (AUC 0.935; at a fixed specificity of 95%: sensitivity – 54.5% and a threshold value for prediction of unfavorable outcome of the operation – ≤295 μm). Among other generally accepted prognostic criteria only tractional hole index had though lower, but not significantly different rates (0.793, 45.5%, ≤0.740 respectively, P> 0.05). At the threshold value ≤295 μm the average thickness of the retina in the foveal zone, showed sensitivity of 55% (6 out of 11 cases) and specificity of 94% (101 out of 107 cases) in the study group; the sensitivity of 57% (4 out of 7 cases) and a specificity of 90% (43 out of 48 cases) in a test group.Conclusion. The SD-OCT allows not only to obtain the detailed information on the structure of the IMH, but to predict with sufficient accuracy the outcomes of the intervention (performed by an experienced surgeon using modern technology). Along with the previously proposed criteria, the average thickness of the retina in the foveal zone is a new, highly informative criterion for the prediction of the anatomical effect of surgical treatment of the IMH, surpassing most other prognostic criteria

Lamellar macular holes

As vitreoretinal surgery develops, treatment issues of lamellar macular holes (LMH) are becoming increasingly important, that requires a comprehensive study of various aspects of this pathology. This review deals with the issues of diagnosis and differential diagnosis, pathogenesis, classification, natural course and surgical treatment of LMH. The data on two types of epiretinal membranes found in cases of LMH, the features of their visualization by optical coherence tomography and histological structure, relation to the clinical findings and the natural course of LMH are presented

MACULAR MICROSTRUCTURE CHANGES AFTER ENDOVITREAL MACULAR HOLE SURGERY

Purpose. To study macular microstructural changes after idiopathic full-thickness macular hole (IMH) surgery.Material and methods. Fifty-seven eyes with IMH of 53 patients were examined by the spectral-domain optical coherence tomography. Subtotal 25G vitrectomy with an internal limiting membrane peeling with the subsequent drainage of subretinal fluid and the air tamponade of vitrous cavity was performed in all cases. The examinations were carried out preoperatively and 1, 3 and 6 months after successful surgery.Results. In postoperative follow-up of 1 month the external limiting membrane (ELM) was clearly visible in 54 eyes, but there was a photoreceptor inner/outer segment junction «defect» (42 cases – group 1), or an ELM deflection which contacted the pigment epithelium (12 cases – group 2). The ELM deflection was not detected 3 months later, but there was the same «defect» as in the group 1. In both groups 3 and 6 months later the size of the «defect» reduced gradually and in several cases it was not present any more. The size of the «defect» was smaller in the group 1 compared to the group 2 in all follow-up (P<0.01). In 3 eyes (group 3) the intact ELM was absent and other structural changes were pronounced 1 month after surgery. In these cases no changes were observed 3 and 6 months after the operation. Conclusion. After the IMH closure the outer retinal layers gradually restore their structure, that is confirmed by a photoreceptor inner/outer segment junction restoration. The ELM integrity evidently plays an important role in the process of photoreceptor repair.><0,01). In 3 eyes (group 3) the intact ELM was absent and other structural changes were pronounced 1 month after surgery. In these cases no changes were observed 3 and 6 months after the operation.Conclusion. After the IMH closure the outer retinal layers gradually restore their structure, that is confirmed by a photoreceptor inner/outer segment junction restoration. The ELM integrity evidently plays an important role in the process of photoreceptor repair

Surgical treatment of retinal detachment with inferior break using combined gas-air tamponade with viscoelastic

Surgical treatment of rhegmatogenous retinal detachment with an inferior break remains a challenge for ophthalmic surgeons. When using silicone tamponade, complications can develop, such as increased intraocular pressure and emulsification of silicone. In recent years, tamponade of the vitreous cavity with a gas-air mixture has been actively used, however, not all patients can observe the forced position face down, and the tamponade itself is not long-term. Purpose. The authors proposed a method for the treatment of rhegmatogenous retinal detachment with an inferior break using a combined tamponade with a gas-air mixture and viscoelastic based on sodium hyaluronate. Material and methods. A clinical observation of a patient successfully operated on with the use of the specified combined tamponade is presented. A detailed description of a new surgical technique is presented, which allows achieving a higher anatomical and functional results. Conclusion. To confirm the effectiveness and safety of the proposed method, further studies on a group of patients are needed

Modern Methods of Surgical Treatment of Proliferative Diabetic Retinopathy Complicated by Traction Retinal Detachment

With the development of vitreoretinal surgery, problems and issues related to various approaches to the treatment of proliferative diabetic retinopathy are becoming increasingly important. This review presents the issues of pathogenesis, epidemiology, classification, surgical treatment of proliferative diabetic retinopathy, as well as the evolution of the technique, and its transition from the application of greater surgical access to small. The data on the existence of surgical access through a small caliber, bimanual technique, types of tamponade substances used in the course of surgical intervention in this pathology are given. Also, in this review is considered a phased surgical technique in the treatment of traction retinal detachment, tools used, including vitreous, endovitreal tweezers, endovitreal scissors and others. Despite advances in the treatment of ocular manifestations of diabetes mellitus, glycemic control, advances in laser surgery, vitreoretinal surgery, traction retinal detachment remains a serious problem, causing decreased vision in patients with both type I and type II diabetes, and requires immediate surgical intervention

Surgical management of spontaneous vitreous hemorrhage, presumably of rhegmatogenous origin

Relevance. There are many causes of spontaneous hemorrhage into the vitreous cavity. Sometimes spontaneous nontraumatic vitreous hemorrhage can be rhegmatogenous in nature, occurring as a result of a ruptured retinal vessel running through the site of a retinal tear. Usually, a patient with spontaneous nontraumatic vitreous hemorrhage is managed with a conservative approach, but it is questionable whether conservative management of patients with this pathology is advisable. Purpose. To evaluate the results of surgical treatment of patients with idiopathic, presumably rhegmatogenous vitreous hemorrhage. Material and methods. Surgical treatment of 10 patients diagnosed with idiopathic vitreous hemorrhage, presumably of rhegmatogenous nature, was performed and the results of treatment were evaluated. The best corrected visual acuity (BCVA) before treatment was on average 0.03. Slit lamp examination revealed dispersed vitreous hemorrhage into the vitreous body with a total obscuration of the posterior pole. According to B-scan data there was no retinal detachment in all cases. All patients underwent surgical treatment. Results. By the third month of follow-up after surgical treatment, visual acuity was 0.9±0.04 on average. B-scan data showed no pathology in all cases. Light sensitivity was 28.7±0.15 dB on average. Conclusion. If other obvious causes of vitreous hemorrhage are excluded, urgent surgical treatment is, in our opinion, the most preferable approach and can be recommended as a first line of treatment instead of conservative therap