Oftalʹmologiâ (Jul 2018)
A Retrospective Analysis of the Results of Microinvasive Posterior Vitrectomy in the Surgical Treatment of Non-Full Thickness Macular Holes
Abstract
Purpose: to study the effectiveness of the posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes on the basis of the retrospective analysis of the retina changes, identified by OCT, and functional outcomes of surgical treatment.Patients and Methods. A retrospective analysis of outcomes of posterior microinvasive vitrectomy was performed in 30 patients operated about non-full thickness macular holes. The following features were assessed: maximum diameter of the non-full thickness macular holes, the diameter at the base of the hole, the minimum thickness of the retina before and after operation, the maximum thickness of the retina before and after surgery. In addition, the configuration of the hole edges before surgery, the presence of intraretinal cysts before and after surgery, the integrity of the ellipsoid zone of the photoreceptors before and after the operation and the restoration of fovea centralis as a result of surgical treatment were assessed.Results. As a result of surgical treatment the closure of non-full thickness macular holes was reached in all cases. The most corrected visual acuity in the postoperative period was ranged from 0.1 to 1.0 (0,66 ± 0,04). The visual acuity improved in 20 cases (64.5%), remained at the same level in 8 cases (25.8%) and decreased in 3 cases (9.6%, in 1 case due to the development of cataracts). The results of correlation analysis has allowed to establish correlation between the initial BCVA and the maximum retinal thickness (R = –0.4), and residual retinal thickness in the area of the hole (R = –0.3). The increase in visual acuity after surgical treatment significantly affected the recovery of the ellipsoid zone of the photoreceptors (RD = 0.833), regression of the retinal thickness (R = 0.42). In addition, the initial diameter of non-full thickness macular holes, both external and at the base, also had an impact on the increase in BCVA (R = –0.3 and R = –0.25, respectively).Conclusion. Posterior microinvasive vitrectomy in the surgical treatment of non-full thickness macular holes is a highly effective method of treatment, as evidenced by the closure of the defect and improvement or stabilization of the most corrected visual acuity 90.4% cases. On the basis of the retrospective analysis it is found that the most significant increase in the most corrected visual acuity was increased in patients with low visual acuity. The recovery of the ellipsoid zone of photoreceptors, regression of the retinal thickness and the diameter of non-full thickness macular holes, both external and at the base mostly influences nn the recovery of the most corrected visual acuity.
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