Internal Aspiration in Macular Hole Surgery: A Retrospective Comparative Study
Ke Xu, Yanfeng Liao, Dan Li, Shuang Cui, Xuefeng Feng, Changguan Wang, Huijin ChenPurpose
To compare the structural and functional outcomes of pars plana vitrectomy (PPV) with or without aspiration of fluid from inside the macular hole for primary full‐thickness macular holes (FTMHs).
Methods
We retrospectively analyzed the hole closure rate, the integrity of the ellipsoid zone (EZ), central retinal thickness (CRT), and best‐corrected visual acuity (BCVA) from 101 eyes of 101 patients with primary medium‐to‐large FTMH who underwent PPV with aspiration or nonaspiration technique within 1 month.
Results
At 1 month postoperatively, Type 1 closure rates were 81.4% (48/59) in the aspiration cohort and 83.3% (35/42) in the non‐aspiration cohort; U‐type closure rates were 49.2% (29/59) and 52.4% (22/42), respectively. After the 1‐month visit, 61 of the 101 eyes (60.4%) were lost to follow‐up; the remaining 40 eyes (24 in the aspiration cohort and 16 in the nonaspiration cohort) were also analyzed at 3–6 months postoperatively. At 3–6 months postoperatively, Type 1 closure rates were 75.0% (18/24) in the aspiration cohort and 87.5% (14/16) in the non‐aspiration cohort; U‐type closure rates were 58.3% (14/24) and 62.5% (10/16), respectively. No significant between‐cohort differences were found in the unadjusted analyses; multivariable models likewise showed no significant association of aspiration with closure or BCVA. BCVA of the 40 eyes (Cohort 1 + Cohort 2) showed no significant change from baseline (1.00 logMAR [Q1–Q3: 0.92–1.40]) to 1 month postoperatively (1.05 logMAR [Q1–Q3: 0.92–1.49 logMAR]) and improved significantly at 3–6 months postoperatively (0.82 logMAR [Q1–Q3: 0.52–1.00 logMAR]) ( p < 0.001), which was correlated with a significant decrease in the EZ defect from 1443.50 μm (Q1–Q3: 1053.50–1875.50 μm) at 1 month to 797.00 μm (Q1–Q3: 264.75–1610.00 μm) at 3–6 months ( p = 0.003).
Conclusion
Aspiration of fluid from inside the macular hole seems to provide no additional benefit in this retrospective study for the surgical treatment of medium‐to‐large primary FTMHs. Improvement in postoperative visual function occurs simultaneously with the reduction of EZ defects.