Modern technologies of surgery of central retinal detachment with macular hole in patients with critically high myopia

Rationale: A major problem at present is the imperfection of approaches and the effectiveness of surgical treatment of macular holes of various diameters associated with central retinal detachment in patients with high myopia and scleral staphyloma. The main difficulty lies in creating an effective tamponade of the vitreous cavity necessary to close the macular hole and blocking of the macular hole itself in the presence of scleral staphyloma. Silicone oils are used as a tamponing agent in most cases, their viscous properties do not always allow the retina to be fully adapted. The search for alternative methods of surgical treatment should increase the anatomical and functional effectiveness of treatment. Objective: The aim of the work was to analyze the results of surgical treatment in patients with central retinal detachment against the background of macular holes of various diameters in patients with high myopia and scleral staphyloma using autologous conditioned plasma (ACP) as a hole blocking composite and pneumoretinopexy as the final tamponade. Methods: Surgical tactics included subtotal vitrectomy 25+, 27G, peeling of the inner limiting membrane, pneumoretinopexy, introduction of ACP into the area of scleral staphyloma through the macular hole, and after the formation of a plasma seal at the base, application of ACP to the surface of the retina in the area of the hole in 2-3 layers up to formation of a resistant ACP layer. The operation was completed seamlessly, blocking the sclero-conjunctival access by applying 2-3 layers of ACP to the surface of the sclera and conjunctiva. Using this technique, 22 patients with central retinal detachment and macular hole with a diameter of 700-2200 microns against the background of high myopia and with severe scleral staphyloma were operated. Results: As a result of the treatment in the early and late postoperative period, the retina was completely adjacent and the macular hole was blocked in all patients. Conclusion: Thus, this technique is the most sparing and highly effective; it allows to achieve full anatomical fit of the retina and closure of the macular hole, eliminates the need for silicone tamponade, minimizes the risk of postoperative complications in patients with central retinal detachment and macular holes of various diameters in patients with high myopia and scleral staphyloma.