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Dinámica postoperatoria de los agujeros maculares de espesor total: perspectivas de la OCT de alta resolución bajo
Anibal Francone1, Andrea Govetto2, Juan Peñalva1
1Retina Division, Centro Oftalmológico Dr Charles S.A., Buenos Aires, Argentina.
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.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
