Evaluation of long-term results of surgical treatment of macular holes of medium and large diameter by inversion and fixation of the free flap of the inner boundary membrane

    Abstract

    Original article

    Evaluation of long-term results of surgical treatment of macular holes of medium and large diameter by inversion and fixation of the free flap of the inner boundary membrane

    D.I. Bronskiy, A.G. Shchuko

    S. Fyodorov Eye Microsurger y Federal State Institution, Irkutsk branch, Irkutsk, Russian Federation
Irkutsk State Medical University, Irkutsk, Russian Federation
Irkutsk State Medical Academy of postgraduate education — Branch of the Russian Medical Academy of Continuing Professional Education, Irkutsk, Russian Federation

    Relevance. Vitrectomy with the covering of the macular defect with an inverted flap of the inner boundary membrane (IBM) is one of the promising areas of macular hole surgery (MH). However, anatomical closure of a macular defect is not always accompanied by visual functions increase.

    Purpose. To evaluate the possibility and degree of restoration of the retinal structure and visual functions after surgical treatment of medium and large diameter MH using the method of inversion and fixation of the free flap of the IBM.

    Material and methods. The prospective study included 40 patients (40 eyes) with medium and large diameter MH, average age 67.5±5.31 (56–78) years. In the long-term postoperative period, all patients, depending on the received visual acuity, were divided into 3 groups: group 1 — an increase in visual acuity by 0.1 or more, group 2 — no changes in visual acuity, group 3 — visual impairment by 0.1 or more.

    Results. In the first group, in the long-term postoperative period, there was a significant increase in visual acuity from 0.16±0.14 to 0.46± 0.2 (p=0.002), accompanied by the formation of a U-shaped macular profile. In the second group, despite the subjective improvement in the quality of vision, visual acuity remained at the preoperative level of 0.2±0.07 (p≥0.05). In the third group, there was a moderate and unreliable decrease in visual acuity to 0.2±0.08 compared with preoperative indicators of 0.27±0.09 (p≥0.05).

    Conclusion. Endovitreal intervention in MH of medium and large diameter using the technology of inversion and fixation of the free flap of the IBM is highly effective, allowing to achieve 100% anatomical closure of the macular defect, provided the correct intraoperative location and normal postoperative adaptation of the flap of the IBM. The possibility of restoring visual functions is determined by the initial state of the hole, in which the most significant criteria are the correspondence of the minimum and maximum diameter of the hole, the absence of epiretinal proliferation and the duration of the hole up to 3 months determine the closure of the U-type hole, the restoration of the ellipsoid zone and the functional activity of the retina.

    The predictors of V- and W-type macular hole closure are: a trapezoidal hole shape with an initial maximum diameter significantly larger than the minimum diameter; a mean hole height of 357.2±44.9 µm; the presence of intraretinal cyst resorption; and evidence of preretinal fibrosis. As a result, recovery of the ellipsoid zone and the patient’s visual function is not anticipated.

    Keywords: macular hole, internal boundary membrane, multifocal ERG, visual functions restoration

    For citation: Bronskiy D.I., Shchuko A.G. Evaluation of long-term results of surgical treatment of macular holes of medium and large diameter by inversion and fixation of the free flap of the inner boundary membrane. Fyodorov Journal of Ophthalmic Surgery. 2025;4(147): 111–120.

    DOI: 10.25276/0235-4160-2025-4-111-120

    Corresponding author: Denis I. Bronskiy, nauka.mntk.irkutsk@mail.ru