Retinal damage during membrane peeling initiation in patients with macular hole and rhegmatogenous retinal detachment

Relevance Three-port vitrectomy with membrane peeling is considered a standard method for treating patients with macular hole (MH) and retinal detachment (RD) [1, 2]. However, this manipulation entails a high risk of iatrogenic paramacular holes [3]. When choosing the zone of the initiating pinch, surgeons give preference to the temporal segment of the parafovea. Objective To track the dynamics of changes in the morphology of the retinal parameters in the membrane peeling initiation zone in patients with MH and RD. Material and methods Data from 40 patients (40 eyes) diagnosed with MH and RD were studied. 20 patients in the 1st group did not undergo manipulations in the macular zone during the first intervention. Plastic surgery of the hole was performed during the second operation to remove silicone. Patients in the 2nd group had MH blocked using partial peeling of the ILM and an inverted flap during the first intervention. During the second operation, silicone oil was removed. Results After a year and a half of observation, when assessing the volume of the inner retinal layers in patients of the 2nd group, the value in the temporal zone of the parafovea was 1.59 times lower, the indicator was 0.172 ± 0.012 mm3 (p = 0.042). Conclusion When performing membrane peeling in patients with MR and OS, iatrogenic damage to morphology persists for up to one and a half years after surgery. This emphasizes the importance of careful selection of treatment tactics. Refusal to remove the ILM on a mobile detached retina leads to a decrease in aggressive mechanical trauma to the retinal tissue. Key words: macular hole; retinal detachment; membrane peeling