METHOD FOR SURGICAL TREATMENT OF PRIMARY END-TO-END MACULAR RUPTURE WITH THE FORMATION OF AN UPPER INVERTIBLE FRAGMENT OF THE INNER BOUNDARY MEMBRANE Russian patent published in 2022 - IPC A61F9/07 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology. Preoperative calculation of individual parameters for each patient and the localization zone of the upper invertible fragment (UIF) of the inner boundary membrane (IBM) is performed. The data obtained as a result of the calculation are applied to the individual processing map of the patient’s fundus. At the same time, in order to preserve the point of visual fixation, the zone of the foveolar intact fragment (FIF) of the IBM is determined, which is a rounded section of IBM located concentrically to the minimum diameter of MP and captures the point of visual fixation, determined by microperimetry data, so that it is located in the middle between the edge of MP and the outer border of the IBM FIF. At the same time, the maximum width of the IBM FIF concentrically to the macular hole does not exceed 500 microns. The IBM UIF has the shape of a square, the sides of which are equal to the diameter of the circumference of the IBM FIF and is located on top relative to MP. During the surgical intervention, based on the preoperative calculation, the IBM UIF is formed using the method for step-by-step formation of IBM fragments, namely: from the side of the inferior vascular arcade 2.5 mm from the edge of the rupture, the IBM tear is performed with a tweezer and its local fragment is separated from the retina. Next, the IBM is separated along the arc of an imaginary circle with a macular hole in the center, the length of the removed fragments of the IBM is 3 hour meridians. At the same time, the area of the retina at a distance of 1.2 mm from the edge of the gap is kept intact. Next, the separated IBM is intercepted at the end point and, by moving along the radius of the circle to the center of the MP, the IBM is separated without reaching the edge of the gap by the preoperatively calculated width of the IBM FIF. Then the next interception is performed at the end point and the IBM is separated from the surface of the retina for 3 hour meridians in the opposite direction. The removal of a fragment of the IBM is completed by a movement directed along the radius, in the direction of the original point. The above-described algorithm of movements is repeated, thereby forming an IBM FIF concentrically to the macular hole. The last section of the IBM is removed in such a way as to prevent the closure of the IBM removal site at a distance equal to the preoperatively calculated width of the IBM UIF located on the side of the upper vascular arcade relative to the macular opening. Then the IBM UIF is separated: the separation of the IBM UIF from the retina surface is carried out to the upper border of the IBM FIF. Next, the IBM UIF is turned over and placed on the macular hole. After that, the liquid is replaced with an air mixture; drainage of the subretinal fluid through the gap is not carried out.

EFFECT: method makes it possible to create a single-layer flap of an IBM of the required shape, size and localization with an upper invertible fragment, complete closure of the macular opening, restore the integrity of the retina in the fovea, reduce the traumatic nature of surgical intervention, minimize the risk of intra- and postoperative complications, achieve high visual functions.

1 cl, 1 ex, 3 dwg