Title : Surgical treatment of chronic macular hole by hydraulic mobilization of the central parts of the retina
Abstract:
Objective: to evaluate the safety and effectiveness of the technique of hydraulic mobilization of the central parts of the retina in the surgical treatment of chronic macular ruptures.
Materials and methods: 11 patients (11 eyes) with chronic macular rupture were under observation. All patients underwent a standard 3-port seamless 25-gauge vitrectomy with removal of the cortical layers of the vitreous body to the equator. After staining, the inner boundary membrane was removed according to the standard procedure. To mobilize the retina around the rupture, subretinal injections of a balanced saline solution were performed within the maculorexis area using a PolyTip 25/38 subretinal cannula connected to a syringe filled with BSS. Subretinal injections were performed using a four-point method. The criterion for the end of the injection was the appearance of a wave of liquid from the injection site to the edge of the rupture. All four waves should be connected 360 degrees around the gap. During this procedure, the infusion pressure was temporarily reduced to 15 mmHg. Next, the fluid was replaced with air with drainage of subretinal fluid through a macular rupture. The operations were completed either by tamponade of the vitreal cavity with air, or 16% hexafluoroethane (C2F6) After surgery, the patients were in the "face down" position for 3 days.
Results and discussions: Complete anatomical closure of the macular rupture was achieved in all cases. The closure of the gap was stable throughout the entire observation period. There were no complications associated with retinal mobilization. The average value of the maximum corrected visual acuity (CMOS) in the affected eye before the intervention was 0.05 ± 0.01. The postoperative mean CMOS was improved to 0.4 ± 0.23. CMOS values after surgery were significantly increased in all cases (P = 0.001).
