After vitrectomy and internal limiting membrane peeling and ensuring that no peripheral retinal break is there, fluid-air exchange is done in macular hole surgery. Some of my colleagues drain/aspirate fluid from the optic disc. Some say the fluid should be aspirated from the macular hole itself rendering it dry.
What should be the ideal approach and what is the supporting evidence?
Drain at the hole to- make sure soft silicone tip never gets to touch RPE and suction has to be low20-50mmHg with 25 G ;And air/gas exchange should extend to ~10 minutes....
In my experience, mostly it is sufficient (and safer) to aspirate only over the optic disc. As long as there is an adequate tamponade, any remaining SRF will be 'absorbed' by the RPE as per a rhegmatogenous detachment. Usually it is not necessary to have a completely dry MH for closure. I also do not routinely posture patients post-op either - just avoid a supine position. Hope that helps
You don’t need to aspirat through the hole specially if you are using a long acting gas like c2f6. You may need to leave the retina dry at the end of the operation if you are using air only.