Analysis of the process of recovery of the foveolar region after surgery of idiopathic macular ruptures by the «temporal inverted VPM flap» method

Purpose. To analyze the recovery of the foveolar region after successful surgery of idiopathic macular rupture (IMR) using the "temporal inverted VPM flap" method. Material and methods. In 33 patients (34 eyes) aged 65.2±8.1 years, operated on for stage II-IV IMR according to J. Gass (1995), in the postoperative period for up to 1 year, changes in the foveolar region were studied by optical coherence tomography (OCT). Results. Recovery of the foveolar area began from the first days after the operation and lasted for 12 months. In the period from 1 week to 1 month, the recovery and approximation to the U-shaped foveolar contour was noted in all patients. At the final follow-up period: the outer boundary membrane and the ellipsoid zone were completely restored in 26/44 (76%) and 23/34 (68%) eyes, respectively; the average central retinal thickness decreased from 396±62.6 microns to 194±66 microns (p<0.05); the corrected distance visual acuity (CDVA) increased from 0.07±0.04 to 0.35±0.21 (p<0.05). Conclusion The "temporal inverted VPM flap" method is highly effective in the surgery of idiopathic macular ruptures. The process of restoring the microstructures of the foveolar zone begins from the first days after the IMR surgery using the "temporal inverted VPM flap" method, is gradual and lasts up to one year from the start of treatment. The main stages of restoration of the microstructures of the foveolar region are: mechanical overlap of the macular rupture with HPV flaps, filling of the IMR lumen with a "glial plug", restoration of the external photoreceptor layer of the fovea. Key words: foveolar region, outer layers of the retina, idiopathic macular rupture, temporal inverted VPM flap, optical coherence tomography.