Full-Thickness Macular Hole Surgery: A Comparison of Ten Techniques (FTMH-10)
Vitreoretinal Surgery for Full-Thickness Macular Hole: A Comparative Study of Ten Techniques
Studie Overzicht
Toestand
Conditie
Gedetailleerde beschrijving
Full-thickness macular hole is a vision-threatening condition that is commonly treated with pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. While standard approaches achieve high closure rates in many cases, outcomes may vary depending on macular hole size and OCT morphology, and advanced surgical strategies (e.g., different ILM flap configurations, adjunctive biologic augmentation, hydrodissection, or grafting techniques) are increasingly used in clinical practice.
This single-center, randomized, parallel-group interventional study will compare ten PPV-based surgical techniques for full-thickness macular hole repair. Eligible participants will include adults with full-thickness macular hole across a broad range of minimum linear diameter (MLD), including MLD <250 µm. After eligibility confirmation and informed consent, participants will be randomized to one of the ten procedure groups. Randomization will be stratified by macular hole size into five predefined MLD strata to ensure balanced distribution of hole sizes across all intervention groups. Postoperative care and follow-up procedures will be standardized across groups according to the study protocol.
Follow-up visits are scheduled at Day 7, Month 1, and Year 1 after surgery and will include clinical examinations and OCT imaging. The primary endpoint is anatomical macular hole closure on OCT at the prespecified primary time point. Secondary endpoints include best-corrected visual acuity (BCVA), OCT-based morphologic recovery parameters, intraoperative and postoperative complication rates, reoperation rates, and adverse event information through Year 1. The study aims to generate evidence to guide selection of surgical technique based on macular hole morphometric and clinical characteristics while maintaining patient safety.
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: Kairat Ruslanuly, MD
- Telefoonnummer: +77019008387
- E-mail: ruslanuly.kairat@gmail.com
Studie Contact Back-up
- Naam: Sanzhar Sambet, MD
- Telefoonnummer: +77758719834
- E-mail: sanzhrs@gmail.com
Studie Locaties
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Almaty
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Almaty, Almaty, Kazachstan, 050042
- Werving
- Kazakh Eye Research Institute
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Contact:
- Sanzhar Sambet, MD
- Telefoonnummer: +77758719834
- E-mail: sanzhrs@gmail.com
-
-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
Adults aged ≥18 years.
Full-thickness macular hole (FTMH) eligible for pars plana vitrectomy (PPV).
Symptom duration ≤12 months.
Clear ocular media sufficient for high-quality OCT imaging.
No prior pars plana vitrectomy in the study eye.
No severe foveal atrophy on OCT.
Able and willing to comply with postoperative positioning and follow-up visits.
Written informed consent provided.
Exclusion Criteria:
A. Etiology-Related / Secondary Macular Holes:
Traumatic macular hole.
High myopia with posterior staphyloma (axial length >28 mm and/or spherical equivalent ≤-8.0 D).
Diabetic tractional retinal detachment (TRD) or significant tractional maculopathy.
Retinal vascular occlusion-related macular hole.
Uveitis-related macular hole.
Advanced age-related macular degeneration (AMD) with foveal atrophy.
B. Prior Interventions:
Any prior pars plana vitrectomy in the study eye.
C. Ocular Conditions That May Affect Outcomes or Safety:
Active or recent ocular infection or inflammation (e.g., uveitis, endophthalmitis, keratitis).
Uncontrolled glaucoma (intraocular pressure >28 mmHg despite treatment).
Media opacity precluding adequate OCT (e.g., dense cataract or corneal opacity).
Geographic atrophy involving the fovea.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Dubbele
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Actieve vergelijker: PPV + PVD Induction Without ILM Peel/Flap
Pars plana vitrectomy (PPV) with induction of posterior vitreous detachment (PVD) performed without internal limiting membrane (ILM) peeling and without an ILM flap.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
|
|
Actieve vergelijker: PPV + ERM peel + circular ILM peel (classic)
Pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peeling (if present) followed by standard circular internal limiting membrane (ILM) peeling around the fovea (classic technique).
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
|
|
Actieve vergelijker: PPV + 360° Inverted ILM Flap
Pars plana vitrectomy (PPV) with creation of a circumferential (360°) internal limiting membrane (ILM) flap that is inverted to cover the macular hole, according to the study protocol.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
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|
Actieve vergelijker: PPV + Superior Hinged ILM Flap
Pars plana vitrectomy (PPV) with creation of a superior hinged internal limiting membrane (ILM) flap left attached at the superior edge and inverted to cover the macular hole, according to the study protocol.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
|
|
Actieve vergelijker: PPV + Temporal Hinged ILM Flap
Pars plana vitrectomy (PPV) with creation of a temporal hinged internal limiting membrane (ILM) flap, left attached at the temporal edge, and inverted to cover the macular hole, according to the study protocol.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
|
|
Actieve vergelijker: PPV + Multiflap ILM Flap (Cabbage Leaf/Star)
Pars plana vitrectomy (PPV) with creation of multiple small internal limiting membrane (ILM) flaps (multiflap "cabbage leaf/star" technique) positioned to cover the macular hole, according to the study protocol.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
|
|
Actieve vergelijker: PPV + ILM removal + inverted flap + PRP
Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) removal and an inverted ILM flap technique.
Autologous platelet-rich plasma (PRP) is applied to the macular hole area as an adjunct, according to the study protocol.
|
Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
Autologous platelet-rich plasma (PRP) applied intraoperatively to the macular hole area as an adjunct to surgery, according to the study protocol.
|
|
Actieve vergelijker: PPV + ILM removal + PRP
Pars plana vitrectomy (PPV) with standard internal limiting membrane (ILM) peeling (no ILM flap technique).
Autologous platelet-rich plasma (PRP) is applied to the macular hole area as an adjunct, according to the study protocol.
|
Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
Autologous platelet-rich plasma (PRP) applied intraoperatively to the macular hole area as an adjunct to surgery, according to the study protocol.
|
|
Actieve vergelijker: PPV + ILM Peeling + Human Amniotic Membrane (hAM) Graft
Pars plana vitrectomy (PPV) with standard internal limiting membrane (ILM) peeling followed by placement of a human amniotic membrane (hAM) graft for full-thickness macular hole repair, according to the study protocol.
|
Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
Human amniotic membrane (hAM) graft placed intraoperatively for macular hole repair, according to the study protocol.
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Actieve vergelijker: PPV + Macular Edge Hydrodissection
Pars plana vitrectomy (PPV) with controlled hydrodissection (hydromobilization) of the macular hole edges using balanced salt solution to gently separate and mobilize the retinal margins before macular hole closure, according to the study protocol.
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Pars plana vitrectomy (PPV) for full-thickness macular hole repair performed according to the randomized assigned technique (e.g., ERM peel, ILM peeling, ILM flap configurations, or macular edge hydrodissection), as specified in the protocol.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Macular Hole Closure at 7 days
Tijdsspanne: 7 day
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Proportion of participants with OCT-confirmed anatomical macular hole closure.
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7 day
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Macular Hole Closure at 1month
Tijdsspanne: 1 month
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Proportion of participants with OCT-confirmed anatomical macular hole closure.
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1 month
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Macular Hole Closure at 1 Year
Tijdsspanne: 1 year
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Proportion of participants with OCT-confirmed anatomical macular hole closure.
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1 year
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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BCVA at Day 7
Tijdsspanne: 7 days
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Best-corrected visual acuity (BCVA) measured at Day 7 after surgery and recorded in logMAR units.
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7 days
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BCVA at 1 Month
Tijdsspanne: 1 month
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Best-corrected visual acuity (BCVA) measured at 1 month after surgery and recorded in logMAR units.
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1 month
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BCVA at 1 Year
Tijdsspanne: 1 year
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Best-corrected visual acuity (BCVA) measured at 1 year after surgery and recorded in logMAR units.
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1 year
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Sanzhar Sambet Sambet, MD, Kazakh Eye Research Institute
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- IRB-538-2026
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