Hydromassage of macular hole edges for large and persistent full-thickness macular holes
Authors:   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China, Cai Yi , Wei Duo ,   Department of Ophthalmology, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China, Deng Xun ,   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China, Li Xiao-Xin ,   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China; Xiamen Eye Center of Xiamen University, Xiamen 361102, Fujian Province, China, Zhao Ming-Wei ,   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China, Shi Xuan ,   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China, Liang Jian-Hong ,   Department of Ophthalmology, Peking University People&#x2019;s Hospital, Beijing 100044, China; Eye Diseases and Optometry Institute, Beijing 100044, China; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China; College of Optometry, Peking University Health Science Center, Beijing 100044, China
Published: February 2024

AIM: To introduce the macular hole (MH) hydromassage technique as a potentially beneficial approach for the treatment of large or persistent MH.
METHODS: This retrospective observational case series comprised 16 consecutive patients (17 eyes) diagnosed with MH. Inclusion criteria involved a hole aperture diameter larger than 600 μm or the presence of an unclosed MH larger than 600 μm following the previous vitrectomy. Standard MH repair procedures were administered in all cases, involving the manipulation and aspiration of the hole margin through the application of water flow with a soft-tip flute needle. A comprehensive assessment was conducted for each case before and after surgery, and optical coherence tomography (OCT) images were captured at every follow-up point.
RESULTS: The mean preoperative aperture diameter was 747±156 μm (range 611-1180 μm), with a mean base diameter of 1390±435 μm (range 578-2220 μm). Following surgery, all cases achieved complete anatomical closure of MH, with 13 cases (76.5%) exhibiting type 1 closure and 4 cases (23.5%) demonstrating type 2 closure. No significant differences were observed in the preoperative OCT variables between the two closure types. Eyes with type 1 closure showed a significantly improved visual acuity (0.70±0.10, range 0.50-0.80) compared to those with type 2 closure (0.90±0.12, range 0.80-1.00, P=0.014).
CONCLUSION: The MH hydromassage technique demonstrates promising results, achieving acceptable closure rates in cases of large or persistent MH. This technique may serve as an effective adjunctive maneuver during challenging MH surgery.