PERFUSION IN THE MACULA DURING CLOSURE OF FULLTHICKNESS MACULAR HOLE WITH SILICONE TAMPONADE

Background. Despite the development of new surgical techniques, silicone tamponade continues to be an important part of the surgical treatment for full-thickness macular hole (FTMH). However, there has been little research into the potential effect of silicone oil in the vitreous cavity on retinal blood flow in the macular area and functional recovery after surgery.

Aim. To study changes in retinal blood flow in the postoperative period following closure of the FTMH using silicone tamponade.

Materials and methods. The study included 40 patients (40 eyes) with stage 4 idiopathic FTMH, according to the classification of D. Gass. The patients were divided into two subgroups: 20 patients with silicone tamponade and 20 with gas tamponade. The OCT angiography method was used to study the area of the foveal avascular zone (FAZ), vascular density in the superficial and deep capillary plexus (SCP and DCP) in the fovea and parafovea, as well as the apical (minimum) diameter of the macular hole, the area of cystic changes in the inner nuclear and outer plexiform layers, and changes BCVA and retinal sensitivity (RS) at the fovea and parafovea levels. The studies were conducted before surgery and 2 and 6 months afterwards.

Results. In the subgroup with silicone tamponade, two months after macular hole closure, there was a significantly lower vascular density in the SCP and the DCP in the fovea (p = 0.032 and p = 0.034, respectively), as well as a decrease in vascular density in these regions in the parafovea (p = 0.04 and p = 0.029, respectively). Additionally, there were lower mean values for the RS in both the fovea and the parafovea (p = 0.029 and p = 0.031, respectively). The change in the mean foveal and parafoveal RS correlates with changes in the vessel density in the DCP fovea and parafovea (r = 0.34 and r = 0,29 respectively, p<0.05) and with the vessel density in the SCP in the fovea (r = 0.33, p = 0.01), respectively.

Conclusion. Silicone tamponade used in the treatment of FTMH may have a negative impact on macular perfusion, potentially slowing down or reducing the functional recovery of the retina during the early postoperative period. 

1. Gass JDM. Idiopathic senile macular hole: Its early stages and pathogenesis. Arch Ophthalmol 1988;106:629–39. https://doi.org/10.1001/archopht.1988.01060130683026.

2. Liu L, Enkh-Amgalan I, Wang NK, Chuang LH, Chen YP, Hwang YS, et al. Results of macular hole surgery: Evaluation based on the international vitreomacular traction study classification. Retina 2018;38:900–6. https://doi.org/10.1097/IAE.0000000000001647.

3. Lyskin P.V., Volodin P.L., Makarenko I.R. Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method. Russian Ophthalmological Journal. 2023;16(4):44-49. (In Russ.)] https://doi.org/10.21516/2072-0076-2023-16-4-44-49.

4. Rossi T, Bacherini D, Caporossi T, Telani S, Iannetta D, Rizzo S, et al. Macular hole closure patterns: an updated classification. Graefes Arch Clin Exp Ophthalmol 2020;258:2629–38. https://doi.org/10.1007/S00417-02004920-4.

5. Arsiutov DG, Pashtaev NP. Modern technologies of surgery of central retinal detachment with macular hole in patients with critically high myopia. Bull Pirogov Natl Med Surg Cent 2022;17:31–3. (In Russ.)] https://doi.org/10.25881/20728255_2022_17_4_S1_31.

6. Gümüş G, Demir G, Tülü Aygün B, Demircan A, Alkın Z, Öztornacı O. Prognostic factors affecting macular hole closure types. Ther Adv Ophthalmol 2021;13. https://doi.org/10.1177/25158414211009007.

7. Baumann C, Iannetta D, Sultan Z, Pearce IA, Lohmann CP, Zheng Y, et al. Predictive Association of Pre-Operative Defect Areas in the Outer Retinal Layers With Visual Acuity in Macular Hole Surgery. Transl Vis Sci Technol 2021;10:7–7. https://doi.org/10.1167/TVST.10.4.7.

8. Joo JH, Nam WH, Joo T, Moon SW. Role of intraretinal cysts in the prediction of postoperative closure and photoreceptor damages of the idiopathic full-thickness macular hole. BMC Ophthalmol 2022;22:1–10. https://doi.org/10.1186/S12886-021-02204-X/FIGURES/3.

9. Boiko E V., Doktorova TA, Suetov AA, Sosnovskii S V. The effect of changes in retinal perfusion on postoperative recovery of foveal function in full-thickness macular holes. Ophthalmol J 2025;18:7–16. (In Russ.)] https://doi.org/10.17816/OV634854.

10. Baba T, Yamamoto S, Kimoto R, Oshitari T, Sato E. Reduction of thickness of ganglion cell complex after internal limiting membrane peeling during vitrectomy for idiopathic macular hole. Eye 2012 269 2012;26:1173–80. https://doi.org/10.1038/eye.2012.170.

11. Shahlaee A, Rahimy E, Hsu J, Gupta OP, Ho AC. Preoperative and postoperative features of macular holes on en face imaging and optical coherence tomography angiography. Am J Ophthalmol Case Reports 2017;5:20–5. https://doi.org/10.1016/j.ajoc.2016.10.008.

12. Bayborodov Y.V., Zhogolev K.S., Khiznyak I.V. Rate of visual recovery after macular hole surgery with intraoperative optical coherence tomography and visualization of the internal limiting membrane. Vestn Oftalmol 2017;133:90–8. (In Russ.)] https://doi.org/10.17116/OFTALMA2017133690-98.

13. Petrachkov D.V., Alkharki L., Matyushchenko A.G., Filippov V.M., Dudieva F.K. Comparison of Early Treatment Outcomes for Large Macular Hole Using Various Surgical Techniques. Ophthalmology in Russia. 2021;18(3S):681-687. (In Russ.)] https://doi.org/10.18008/1816-5095-2021-3S-681-687.

14. Zhang Z, Zhang X, Yao T, Chen J, Huang L, Qiu C, et al. Effect of long-term silicone oil tamponade on the density of blood vessels in the macular and peripapillary region in patients with rhegmatogenous retinal detachment. Int Ophthalmol 2025;45. https://doi.org/10.1007/s10792-025-03460-2.

15. Wang H, Xu X, Sun X, Ma Y, Sun T. Macular perfusion changes assessed with optical coherence tomography angiography after vitrectomy for rhegmatogenous retinal detachment. Graefe’s Arch Clin Exp Ophthalmol 2019;257:733–40. https://doi.org/10.1007/s00417-019-04273-7.