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Cellular-Scale Photoreceptor Remodeling After Macular Hole Surgery Examined by Adaptive Optics Optical Coherence
Yuki Hama1, Yuki Muraoka1, Takahiro Kogo1
1Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Investigative Ophthalmology & Visual Science
|January 20, 2026
Summary
Macular hole surgery triggers outer retinal remodeling, with photoreceptor nuclei and segments reorganizing. Transient hyper-reflective bodies (HRBs) observed during repair may indicate stages of retinal healing.
Area of Science:
- Ophthalmology
- Retinal Imaging
- Cellular Biology
Background:
- Macular holes (MH) are a significant cause of vision loss.
- Understanding outer retinal changes after MH surgery is crucial for improving patient outcomes.
- Adaptive optics optical coherence tomography (AO-OCT) offers cellular-level insights into retinal microstructure.
Purpose of the Study:
- To investigate outer retinal remodeling at the cellular level post-macular hole (MH) surgery.
- To assess the clinical relevance of transient hyper-reflective bodies (HRBs) in the outer nuclear layer (ONL).
- To utilize adaptive optics optical coherence tomography (AO-OCT) for high-resolution imaging.
Main Methods:
- Longitudinal AO-OCT assessment of outer retinal microstructure in 12 eyes post-MH surgery.
- Evaluation of photoreceptor inner segment (IS), outer segment (OS), and ellipsoid zone integrity.
- Monitoring of photoreceptor nuclei visibility and presence/position of HRBs in the ONL.
Main Results:
- Early postoperative phase showed IS/OS disruptions, photoreceptor nuclei loss, and transient HRBs.
- Late phase revealed reappearing photoreceptor nuclei and local restoration of IS, OS, and ellipsoid zone.
- HRB counts decreased over time, with shorter HRB-ELM distances in the late phase.
Conclusions:
- Stepwise outer retinal remodeling occurs in vivo after MH surgery.
- Photoreceptor segment recovery is localized beneath reappearing nuclei, indicating reorganization.
- Diminishing HRBs may represent intermediate remodeling stages and serve as indicators of retinal repair.
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