Internal Aspiration in Macular Hole Surgery: A Retrospective Comparative Study
Related Experiment Video
Updated: Nov 4, 2026
Implantation Protocol of the Foldable Capsular Vitreous Body for Complex Vitreoretinal Surgery
Published on: April 14, 2026
Ke Xu1, Yanfeng Liao1, Dan Li1
1Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Department of Ophthalmology Peking University Third Hospital Beijing China puh3.net.cn.
Purpose:
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.