SELECTING THE METHOD OF INTRAOPERATIVE CLOSING OF LARGE IDIOPATHIC MACULAR HOLE

Purpose
Study the advantages and disadvantages of intraoperative closing methods of large idiopathic macular holes.
Matherials and methods
25 patients (68 eyes) with IMH were observed (18 females, 7 males), average age of patients is 63,3±1,7. Disease lasted 1-24 month. Average size of macular hole (MH) was 524±61 mkm. Visual acuity before input varied from 0,02 to 0,1. Posterior partial vitrectomy 25G with internal limited membrane (ILM) remove was performed for all patients. Operations were finished with air tamponade. Patients were divided on 2 groups. In first group (12 eyes) MH covering (closing) was carried out by the centripetal «mechanical massage» of retina a membrane spatula or silicon canula. In second group (13 eyes) MH covering (closing) of defect tried to get by a centripetal «vacuum massage» a retina and by brief aspiration of edges of break.
Results and discussion
As a result of surgical treatment the complete closing of macular hole is attained in 91,6% cases in a first and in 92,3% - in second groups. Use of method of a «vacuum massage» of retina for intrasurgical covering (closing) of large MH (3-4 stage) declines of frequency of development postsurgical pigment epitheliopathy up to 38,5% and diminishes the time of postsurgical macular odema resorbtion. Average visual acuity after 8 months were higher in second group patients (0,34±0,07), than in first (0,26±0,03) (р<0,05).
Conclusion
Application of technique of a «vacuum massage» of retina for the intrasurgical covering (closing) of large MH reduces the risk of damage of pigmental epithelium of retina, allows to attain best morpho-functional results and early reabilitation.