Poster Ural Altynbaev

An algorithm for a differentiated approach to the removal of the ILM and the choice of tamponade in surgery for stage 2 – 4 macular holes.


The study included 110 patients with stage 2 – 4 idiopathic macular holes. All patients received a partial posterior vitrectomy with removal of the posterior hyaloid membrane. Then for patients with MH of up to 500 microns we aspirated fluid of bed of macular hole, closed the hole with air tamponade, an incomplete closure of the MH and/or trends to differ hole edges meet minimum ILM peeling, repeated the “aspiration test”, with full closure of MH used air tamponade, the incomplete closing of the MH – tamponade of the air-gas mixture (10-20% SF6). When MH 500 microns in diameter after removing the ILM we: performed aspirate fluid bottom MH and vacuum massage centripetal edge hole, closing the MH with air tamponade used, an incomplete closure of the MH – air-gas mixture (10-20% SF6) or silicone oil (1000sSt).


After one operation, full closure of macular holes with a diameter less than 500 microns were observed in 100% of cases. In holes of more than 500 microns in diameter, an 86.6% closure rate was observed. In 5 patients with large macular hole, which was used with air or gas tamponade, a 5-12 day marks the opening of the MH, they were re-operated with positive results. Postoperative (12 months) visual acuity ranged from 0.2 to 1.0.


The proposed algorithm can reduce the frequency of indications for the removal of ILM in macular hole diameter of 300 microns, optimizes the choice of tamponade improves anatomical and functional results of surgery of idiopathic macular hole.