A standardized approach to the choice of basic surgical treatment for large macular holes

The purpose of the study is to optimize the choice of tactics for surgical treatment of large macular holes. Material and Methods. Analysis of the surgical treatment of macular holes in 18 patients (18 eyes) was performed. Patients were divided into 3 groups. Group 1 (8 eyes) included patients with a hole diameter of up to 500±22 urn, group 2 (6 eyes) - with a diameter of up to 800±20 urn, and group 3 (4 eyes) - over 800 urn. In group 1 vitrectomy was performed with peeling of the inner border membrane (IBM), application of platelet rich plasma (PRP) mass and tamponade with air; in the group 2 vitrectomy was performed with IBM peeling, application of PRP mass or closed with a free inverted IBM flap and tamponade with SF6 gas; in group 3 vitrectomy was performed with IBM peeling and closing of the macular holes was performed using a free inverted IBM flap with silicone oil tamponade. Results. There was complete closure of the macular holes with the formation of a normal fovea profile and improvement of visual acuity in all cases of group 1. In group 2 (PRP application) in 2 cases of 6, a second intervention was required with the"plasty" of the macular hole using an inverted IBM flap. In group 3, in 1 case, the gap did not close and in 1 more case it closed with a defect at the level of the ellipsoid zone of the photoreceptors. Conclusion. The preliminary results' analysis showed the effectiveness of the developed algorithm for surgical treatment of macular holes, depending on their diameter, which is optimal and allows obtaining the required anatomical and functional result.