Work

Postoperative Dynamics of Full-Thickness Macular Holes: Insights from High-Resolution OCT Under Gas Tamponade

Year: 2026

Type: article

Abstract: Purpose To characterize early healing processes of full-thickness macular holes (MHs) after pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap using high-resolution swept-source optical coherence tomography (SS-OCT) under gas tamponade. Design Prospective, single-center, interventional, multi-surgeon consecutive case series. Subjects Consecutive eyes with idiopathic full-thickness MHs undergoing PPV with the inverted ILM flap technique. Methods All eyes underwent standardized 25-gauge PPV with temporal inverted ILM flap and 14% octafluoropropane (C3F8) gas tamponade. Pre- and postoperative assessment included high-resolution SS-OCT at predefined intervals from immediately after surgery through 3 months, enabling sequential in vivo evaluation of early and late morphologic changes under gas tamponade. Main Outcome Measures Evaluated features included MH diameter, ILM flap position, hyperreflective bridging tissue, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ). Closure rates and best-corrected visual acuity (BCVA) were analyzed relative to early SS-OCT findings. Results SS-OCT imaging succeeded in all 32 eyes despite the gas-filled vitreous cavity. MH closure was documented in 22 eyes (67%) by Day 1, 29 eyes (88%) by Week 1, and 30 eyes (94%) by Month 1. Early intraretinal hyperreflectivity was observed in 30 eyes (94%), correlating with successful closure; its absence was noted in the delayed cases. ELM regeneration was significantly associated with better BCVA. Mean BCVA improved from 0.89 ± 0.38 logMAR at baseline to 0.47 ± 0.36 logMAR at 3 months (p < 0.001). Based on sequential OCT, a five-step model of MH healing was delineated. Conclusions SS-OCT enables reliable visualization of early MH repair dynamics under gas, revealing potential biomarkers—such as hyperreflective tissue and early ELM restoration—that might predict closure and functional recovery. These findings could suggest that Müller cell activation and gliosis play an active role in scaffolding photoreceptor realignment, recapitulating developmental foveation. Early SS-OCT biomarkers may therefore guide individualized postoperative management.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101078