# Modified two-needle technique of air/fluid exchange for in-office treatment of unhealed macular hole

## TL;DR

A new in-office technique using two needles for air-fluid exchange is introduced to treat unhealed macular holes after surgery.

## Contribution

A modified two-needle method for air-fluid exchange is proposed for in-office treatment of unhealed macular holes.

## Key findings

- The method approximates air-fluid exchange conditions similar to vitrectomy.
- The technique is described as easy, safe, and effective for treating unhealed macular holes.
- Air injection and fluid outflow are balanced naturally through pressure adjustments.

## Abstract

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.

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.

The method approximates the conditions of air-fluid exchange in vitrectomy, and the air injection and liquid outflow are balanced by pressure naturally.

The modified two-needle method is an easy, safe, and effective in-office air-fluid exchange for the treatment of unhealed macular holes.