Dynamics of macular photosensitivity in patients after repeated surgical intervention for previously operated unclosed macular hole

The aim of this study was to develop a universal surgical treatment method for macular holes that failed to close after previous surgical treatment and to analyze the functional results for the efficacy evaluation of the proposed method. Material and methods. The study included 92 patients with a previously operated unclosed macular hole divided into 2 groups according to the repeated surgical intervention: revision of the vitreal cavity + creation of a plug-type free flap of the ILM + ACP mass application + tamponade with an air-gas mixture (group 1) or revision of the vitreal cavity + creation of a plug-type free flap of the ILM + tamponade with silicone oil – SO (group 2). Standard ophthalmologic examinations and microperimetry to assess the functional state of the central retina were performed in all patients before the reoperation and at different periods of postoperative follow-up. Expert testing program (Expert test) was applied, the total sensitivity of the retina was determined in each of the specified 12 points in 3 radii (small (Rmin), medium (Rmed) and large (Rmax)). Results. In patients of both groups, an increase in visual acuity was noted, however, the functional results in group 1 were better than in the silicone oil group. One year after surgical treatment, visual acuity in group 1 was also higher than in the SO tamponade group by 0.2. The light sensitivity of the macular zone along a small radius in the 1st group was higher than in the 2nd by 2.15 dB and 2.5 dB after 1-3 months and a year after the reoperation, respectively. The fixation point stability increased in both groups after reoperation, being 6.33 and 7.33 times higher in group 1 and group 2, respectively, which determines the activation of the foveolar region and correlates with visual function in patients. One year after reoperation, the fixation point returned to the physiological position in 86% of cases compared with the data before surgery in patients of the 1st group, in 75% of cases compared with the data before surgery in patients of the 2nd group, in addition, the number of patients with shifted fixation point in the 1st group was significantly lower than in the 2nd, specifically 1.78 times. Conclusion. The technique involving the use of a plug-like ILM flap, ACP mass application, and tamponade with an air-gas mixture provides better functional results due to the avoidance of toxic and mechanical effects of silicon oil, which is confirmed by the visual acuity and retinal light sensitivity measurements and eliminates the complications possible with the SO tamponade of the vitreal cavity. Key words: macular hole, unclosed, vitreal surgery, internal limiting membrane, autologous conditioned plasma, microperimetry, light sensitivity, silicone oil, revision, visual acuity Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study