Long-term outcomes of surgical treatment for persistent full-thickness macular holes

Background. In a substantial proportion of patients with full-thickness macular holes, recurrence or persistence of the defect may occur even after technically successful primary surgery. At present, no universally accepted surgical strategy exists for the management of persistent macular holes. Purpose: to evaluate the clinical effectiveness of a newly developed combined surgical technique based on internal limiting membrane flap reconstruction for macular holes that failed to close after primary surgery. Materials and methods. The outcomes of the proposed surgical technique were analyzed 3–4 years after reoperation for persistent macular holes. The study included 92 patients aged 66.5 ± 5.5 years who underwent repeat surgery for persistent full-thickness macular holes. Two surgical approaches were evaluated: (1) use of a free internal limiting membrane flap combined with gas-air tamponade and application of autologous conditioned plasma (Group 1, n = 41); (2) use of a free internal limiting membrane flap with silicone oil tamponade (Group 2, n = 51). Optical coherence tomography and microperimetry were the primary assessment methods. Results. Both techniques demonstrated high anatomical success rates and resulted in macular hole closure. However, the technique involving a free internal limiting membrane flap with ACP and gas-air tamponade yielded superior functional outcomes. Patients in this group showed greater improvement in visual acuity (by 0.04; p = 0.003) and retinal sensitivity (by 2.15 dB; p = 0.04) compared with Group 2. These differences are presumably related to the absence of toxic and mechanical effects associated with silicone oil tamponade. Conclusion. The proposed technique using a free internal limiting membrane fl ap combined with gas-air tamponade and autologous conditioned plasma is preferable in terms of functional outcomes, complication minimization, and reduced need for repeat surgical interventions.

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