Ophthalmol Sci. 2026 Jan 19;6(4):101078. doi: 10.1016/j.xops.2026.101078.
Summary
PPV MH hole closed in 67% by day 1 on high-resolution SS-OCT. Early intraretinal hyperreflectivity correlated with successful closure. ELM regeneration correlated with better VA. Prospective, 32 eyes.
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 OCT (SS-OCT) under gas tamponade.
Design: Prospective, single-center, interventional, multisurgeon 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, and integrity of the external limiting membrane (ELM) and ellipsoid zone. Closure rates and best-corrected visual acuity (BCVA) were analyzed relative to early SS-OCT findings.
Results: Swept-source OCT imaging succeeded in all 32 eyes despite the gas-filled vitreous cavity. Macular hole 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. External limiting membrane regeneration was significantly associated with better BCVA. The mean BCVA improved from 0.89 ± 0.38 logarithm of the minimum angle of resolution at baseline to 0.47 ± 0.36 logarithm of the minimum angle of resolution at 3 months (P < 0.001). Based on sequential OCT, a 5-step model of MH healing was delineated.
Conclusions: Swept-source 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.
