The first use of an internal limiting membrane fragment and platelet- rich plasma in surgery for a full thickness macular hole without vitreous tamponade (preliminary results)
Year: 2025
Type: article
Study design: Clinical Trial
Abstract: Aim: to develop a new marginally traumatic surgical technique using a combination of an inverted fragment of the internal limiting membrane (ILM) and platelet rich plasma (PRP) without vitreous tamponade to manage primary full thickness macular retinal ruptures, as well as to study its anatomical and functional effectiveness. Materials and Methods: 23 subjects (23 eyes) aged from 53 to 73 years with primary macular holes (MH) (minimum diameter: 152 — 623 μm) were under medical supervision. The surgical technique performed in the study group included subtotal vitrectomy, formation of an invertible single-layer ILM fragment to block the rupture, ILM preservation in the projection of the papillomacular bundle, PRP application to the surface of the ILM flap with subsequent exposure until formation of the fibrin film, and application of perfluoroorganic compounds to the surface of the ILM flap followed by removal in 5–7 minutes. Vitreous tamponade was not performed. A follow–up period is up to 6 months. Results: no intraoperative complications were observed in the study group. In 1 month after the primary surgery, the MHs closed in 21 subjects (91.3%). Nevertheless, local disorganization or a hyporeflective "defect" was still reported in the ellipsoid zone of the photoreceptors. Two subjects with non-closure of macular holes underwent a reoperation, and the macular hole closed in 1 month. In the study group, the best corrected visual acuity (BCVA) increased on average from 0.3±0.1 to 0.64±0.2 by the end of the follow-up period. The mean central photosensitivity increased from 22.1±2.6 to 27.3±2.9 dB. All the subjects demonstrated an increase in retinal sensitivity and disappearance of absolute scotoma in the center of the fovea. Conclusion: the proposed surgical technique to manage MHs ensures a high functional result combined with a marginally traumatic impact on the retina during the surgical intervention. Although the reported method can increase a functional effectiveness of surgical treatment for primary MHs, further appropriate researches based on sufficient clinical data are required to obtain accurate and reliable data. KEYWORDS: full thickness macular hole, internal limiting membrane, invertible flap, PRP, vitreous tamponade. FOR CITATION: Shilov N.M., Tereshchenko A.V., Plakhotnii M.A., Yudina N.N., Novikov S.V., Kabuldinova S.Zh. The first use of an internal limiting membrane fragment and platelet-rich plasma in surgery for a full thickness macular hole without vitreous tamponade (preliminary results). Russian Journal of Clinical Ophthalmology. 2025;25(Special Issue):82–89 (in Russ.). DOI: 10.32364/2311-7729-2025-25-Suppl-12
Authors: Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation, N.M. Shilov, A.V. Tereshchenko, Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation, M.A. Plakhotnii, Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation, N.N. Yudina, Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation, S.V. Novikov, Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation, S.Zh. Kabuldinova, Kaluga Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga, Russian Federation
Language: English
Topic: Retinal and Macular Surgery
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411958985