Assessment of changes in the retinal ellipsoid zone before and after surgical treatment of penetrating macular holes

Abstract

Relevance. Restoring the retinal integrity during surgical treatment of macular holes (MH) does not always guarantee a significant improvement in visual acuity in the postoperative period. The possibility of regeneration of the retinal ellipsoid zone (EZ), as well as the relationship between the structural restoration of the outer retina and the improvement of visual functions are very contradictory. Purpose. To assess the possibility and degree of repair of the ellipsoid zone in the early and long-term postoperative treatment of MH of medium and large diameters. Material and methods. A prospective study of 13 patients (13 eyes) – 12 women and 1 man with a MH of medium and large diameters was conducted. Patients were divided into 2 groups depending on the presence or absence of an EZ defect after 6 months postoperatively. The structure of the retina was evaluated according to OCT data and the visual acuity of patients in the distance before surgery, 1, 3 and 6 months after MR surgery. Results. In patients with complete restoration of retinal EZ, the initial size of the holes was 1.5 times smaller than in the comparison group, the time from the moment of diagnosis to surgery was 122.7±51.8 and 383.5±125.7 days, respectively. The defect of photoreceptors of the EZ by 1 month after surgery in patients of the first and second groups was 369.6±245.61 microns and 276.07±233.37 microns, respectively. By 6 months of follow–up in the first group, complete closure of the defect was observed, in the second group its decrease to 91.61±97.51 microns, while visual acuity in the first group was 0.46±0.83 by six months of followup and in 3 out of 5 cases it increased to 0.6–0.9, in the second group in all cases this indicator did not exceed 0.5. Conclusion. Complete regeneration of EZ was observed in 38.5% of cases 6 months after surgery, however, anatomical repair of the photoreceptor field of the macular area in the postoperative period does not guarantee improvement of visual functions in all patients. Key words: macular hole, ellipsoid zone, ellipsoid zone regeneration