Results of various approaches to the surgical treatment of large full-thickness macular holes

Rationale: A full-thickness macular hole is a significant cause of decreased visual acuity in patients of the older age group. There are several fairly successful methods of surgical treatment of this pathology. However, the success of surgical threatment significantly depends on the diameter of the hole itself, so vitreoretinal surgeons are actively working to develop and introduce new methods of treating this pathology. Objective: To conduct a comparative analysis of the results of surgical treatment of full-thickness macular holes of large diameter using various surgical methods. Methods: 223 patients (223 eyes) with a diagnosis of a full-thickness macular hole of large diameter were selected: 176 women and 47 men. The age of the examined patients was 66.2±5.8 years (from 52 to 79 years). Follow-up periods of patients: 14 days, 1 month, 6 months and 1 year after surgery. The patients were divided into 3 groups. The main group (Group A) included patients operated according to the developed method. Comparative analysis was carried out with two groups: group B included archival data of patients operated on by standard surgical tactics, group C - patients operated on by the method using platelet-rich plasma. Patients of all groups were divided into subgroups depending on the diameter of the full-thickness macular hole: subgroups A1, B1, C1 included patients with a hole diameter of less than 650 microns, in subgroups A2, B2 and C2 - with a diameter of 650 microns or more. There were no statistically significant differences between the groups (and subgroups). Results: The closure of the full-thickness macular hole in the group of patients operated according to the developed method was achieved in 98.9% of cases (subgroup A 1 and A 2 - 100 and 96.9%, respectively), in the group with the use of platelet-rich plasma - in 96.9% of cases (subgroup C 1 and C 2 - 100 and 90.0%, respectively), in the group of patients who underwent surgery according to the standard procedure-92.9% (subgroup B 1 and B 2 - 96.9 and 85.3%, respectively). In all groups, an increase in the maximum corrected visual acuity was detected after surgery at all follow-up periods. At the same time, statistically significant differences between the groups were revealed for a period of 6 months: the value of the maximally corrected visual acuity was significantly higher in groups A1, C1, A2, C2 compared with groups B1, B2 (p0.01), at the observation period of one year, this trend continued. According to microperimetry data, an increase in central retinal photosensitivity was noted in groups A and C by the observation period of 6 months, while there were no statistically significant differences between the compared groups and subgroups, a similar trend was observed at the observation period of one year. Also among these groups, there was a statistically significant increase in the stabilization of eye fixation after treatment. Conclusion: The method we developed and the method of treatment using platelet-rich plasma showed high results in all parameters, unlike the standard method. The results obtained in groups A and C were comparable.