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Modified two-needle technique of air/fluid exchange for in-office treatment of unhealed macular hole
Jun Chen1, Shiya Mai1, Yayun Wang1
1Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, No.143, Yiman Road, Harbin City, Heilongjiang Province, 150001, China.
Background:
Pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and sterilized air tamponade is used to treat macular hole(MH). Unsuccessful closure of the macular hole may occur after PPV, some caused by insufficient air tamponade or incorrect position. In-office air-liquid exchange may be an option for these patients.
Methods:
A modified two-needle method of air-fluid exchange in office is introduced. A 29-gauge needle is inserted 3.5-mm posterior to the limbus at 6 o'clock. A second 29-gauge needle with a 5mL syringe filled with sterile air is inserted 3.5-mm posterior to the limbus in the superotemporal quadrant or superonasal quadrant. The plunger of the air-filled syringe is pushed while liquid of vitreous cavity flows out of the 6 o'clock needle drop by drop, and the flow rate of the fluid changes with the injection pressure.
Results:
The method approximates the conditions of air-fluid exchange in vitrectomy, and the air injection and liquid outflow are balanced by pressure naturally.
Conclusion:
The modified two-needle method is an easy, safe, and effective in-office air-fluid exchange for the treatment of unhealed macular holes.
Insights
This study presents a new two-needle technique for in-office air-fluid exchange to treat persistent macular holes after vitrectomy. The method ensures balanced air injection and fluid outflow for successful macular hole closure.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Retinal Surgery
Background:
- Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and air tamponade is standard for macular hole (MH) treatment.
- Macular holes may remain unhealed due to insufficient air tamponade or malpositioning.
- In-office air-fluid exchange offers a potential solution for persistent macular holes.
Purpose of the Study:
- To introduce a modified two-needle method for in-office air-fluid exchange.
- To provide an effective treatment option for unhealed macular holes post-vitrectomy.
Main Methods:
- A novel two-needle technique for in-office air-fluid exchange was developed.
- One needle was inserted at 6 o'clock for fluid outflow, while a second needle in the superotemporal or superonasal quadrant injected sterile air.
- The air injection pressure naturally balanced fluid outflow, mimicking in-office vitrectomy conditions.
Main Results:
- The described method achieved balanced air injection and vitreous fluid outflow.
- The procedure naturally regulated flow rates based on injection pressure.
Conclusions:
- The modified two-needle method is a safe, easy, and effective in-office procedure.
- This technique provides a viable treatment for persistent macular holes that did not close after initial surgery.
