Epiretinal proliferation (EP) is associated with poor visual and anatomical outcomes in eyes with macular holes (MHs). A preoperative cross-sectional OCT can detect EP; however, We observed that some cases with intraoperatively visible EP showed no evidence of EP on preoperative OCT. This study assessed the discrepancy between EP observed by OCT and during surgery. We defined OCT-EP as epiretinal materials with homogeneous medium reflectivity observed in cross-sectional OCT. We defined surgical-EP as yellowish tissues contiguous to the hole during the membrane peeling. We detected the surgical-EP by also assessing the internal limiting membrane staining pattern using Brilliant Blue G (BBG) and preretinal abnormal tissue (PAT) using en face OCT. We included 110 eyes. Intraoperative observations revealed surgical-EP in 30 (27%) eyes, while preoperative OCT revealed EP in 26 (24%) eyes. Setting the surgical-EP as the ground truth gave a sensitivity of preoperative OCT for the detection of EP of 87% and specificity of 100%. In 4 of the 30 eyes (13%), EP was not detected on preoperative OCT and all of these eyes exhibited peri-MH nonstaining areas. Peri-MH nonstaining area and peri-MH PAT were larger in eyes with surgical-EP than in eyes without surgical-EP (P = 0.0001 and P = 0.0029).The area under the receiver operating characteristic curve was 84.3% for the peri-MH nonstaining area for detection of surgical-EP and 94.8% for peri-MH PAT. Preoperative cross-sectionalOCT may overlook EP. The BBG staining patterns and en face OCT provide additional clues for detecting EP. Key messages What is known • Epiretinal proliferation (EP) is a known biomarker correlated with poor visual and anatomical outcomes in eyes with macular hole. • Cross-sectional OCT is the standard modality for the detection of preoperative EP but may fail to identify subtle cases. What is new • There is a 13% discrepancy between preoperative OCT and intraoperative observation to detect EP. • Using only preoperative cross-sectional OCT may overlook the presence of EP. • Brilliant blue G staining pattern and en face OCT may be useful to identify undetectable EP by OCT.

To quantify macular pigment optical density (MPOD) in eyes with lamellar macular holes (LMHs) diagnosed according to contemporary optical coherence tomography (OCT) criteria and to evaluate its relationship with structural and functional parameters. This prospective observational study screened 66 patients with unilateral LMH. All participants underwent comprehensive ophthalmic examination, spectral-domain OCT, and MPOD assessment using heterochromatic flicker photometry. Central foveal thickness (CFT), best-corrected visual acuity (BCVA) and OCT features were recorded. Paired inter-eye comparisons and linear mixed-effects regression analyses were performed. Forty-eight patients (48 LMH eyes and 48 contralateral healthy fellow eyes) were included. CFT was significantly reduced in LMH eyes compared with fellow eyes (177.2 ± 13.6µm vs. 251.9 ± 5.9µm; P < 0.0001). MPOD was lower in LMH eyes than in fellow eyes (0.508 ± 0.096 vs. 0.583 ± 0.097; P < 0.0001), and BCVA was worse (P < 0.0001). In multivariable analysis restricted to LMH eyes, MPOD was independently associated with age (β = -0.010 per year; 95% CI, -0.018 to -0.003; P = 0.0085) and BCVA (β = -0.494 per logMAR; 95% CI, -0.910 to -0.079; P = 0.0207), but not with CFT (P = 0.1438). In eyes with marked foveal thinning (CFT < 180µm; n = 26), MPOD was reduced (P = 0.0065). MPOD is reduced in eyes with OCT-defined LMH and is associated with BCVA. As MP is preferentially localized within the Müller cell cone, altered MPOD may reflect foveal remodeling or MP redistribution related to EP.

To investigate long-term outcome of retinal displacement for 1 year after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling and evaluate its association with basal MH size. This retrospective study included seventy eyes of 70 consecutive patients undergoing MH surgery with ILM peeling. Retinal distance from the temporal edge of optic disc to the intersection or bifurcation points of retinal vessels was quantified using near-infrared images. Rates of change in retinal distance were calculated as retinal displacement (%RD). The basal and minimum diameters of the MHs were measured using Spectralis. The average retinal distance in the nasal sector did not change in the early postoperative period but decreased significantly at 6 months and 1 year (P < 0.001). In other sectors, retinal distance continued decreasing for 1 year (P < 0.001). %RD in the nasal sector was smaller than that in the temporal, superior, and inferior sectors at 12 months (all P < 0.001). %RD in the superior sector was larger than in the inferior sector (P = 0.011). Correlations of temporal %RD with horizontal and vertical basal MH diameters appeared at 1 month (rs = -0.301, P= 0.011 and rs = -0.277, P = 0.020) and were more evident at 1 year (rs= -0.565 and -0.512, P < 0.001). Retina surrounding MH keeps moving asymmetrically toward the optic disc for 1 year. Movement of temporal retina after ILM peeling may play an important role in the successful closure of MH.

Pediatric Macular Hole Outcomes with Surgical and Non-Surgical Management: An IRIS® Registry Study.

To survey current practice and opinion regarding the timing of idiopathic full thickness macular hole (iFTMH) surgery among consultant vitreoretinal surgeons in the United Kingdom (UK), and to provide an overview of the current literature and future direction. An online survey was sent to all members of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS). Literature search and analysis were conducted on studies that investigated the timing of vitrectomy surgery for iFTMH. A total of 33 responses was received from all regions of the UK except Northern Ireland. The timing from the onset of symptoms to the first vitreoretinal clinic appointment ranged from 1 to 60 months, with a mean of 6.66 ± 10.8 months (95% CI 2.75-10.6). In terms of surgical prioritisation on the listing form, 42.4% (n = 14) were listed as P2 (less than 1 month), 54.5% (n = 18) were listed as P3 (less than 3 months), and 3.03% (n = 1) were listed as P4 (more than 3 months). The average time from the onset of symptoms to operation date in this cohort was 9.87 months. When asked in an ideal world, would they have liked the surgery to be done sooner, the majority (72.7%, n = 24) said 'yes'. The survey found that there were regional variations in waiting times and surgical prioritisation. Expanding teleophthalmology and establishing elective vitreoretinal surgical hubs are crucial for ensuring timely access to care for all iFTMH patients in the UK.

Purpose To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large macular hole (MH) &amp;gt; 400 μm with or without Hole-door structures. Methods This retrospective study analyzed 56 patients with MH &amp;gt; 400 μm. Based on hole edge morphology evaluated by archived intraoperative optical coherence tomography (iOCT) images, patients were divided into the Hole-door group (Group 1) and the Negative group (Group 2). Within each group, patients were further classified into two subgroups based on the surgical technique performed: complete ILM removal (Group 1-a, 2-a) and visco-assisted ILM flap (Group 1-b, 2-b). External limiting membrane (ELM) and ellipsoid zone (EZ) restoration and best-corrected visual acuity (BCVA) were assessed at 3 and 6 months post-surgery. Results Correlation analysis found no significant link between preoperative MHD and postoperative outcomes. The Hole-door group showed better vision, ELM, and EZ recovery than the Negative group, regardless of ILM removal or visco-assisted ILM flap ( P &amp;lt; 0.05). In evaluating the prognoses between both techniques for macular holes with or without Hole-door structures, at 6 months, BCVA and ELM/EZ restoration were similar in Groups 1-a and 1-b ( P &amp;gt; 0.05), but at 3 months, Group 1-b showed better results ( P &amp;lt; 0.05). In the negative subgroups, Group 2-b outperformed Group 2-a in BCVA and ELM and EZ restoration at 6 months ( P &amp;lt; 0.05) and in BCVA and ELM restoration at 3 months, though not in EZ restoration ( P &amp;lt;0.05) Furthermore, functional and anatomical outcomes at 3 months showed significant correlation with the 6-month results, despite the ongoing microstructural improvements identified between these two time points. Conclusion Large macular holes with Hole-door structures have a better prognosis than those without. In these cases, BCVA and retinal microstructure restoration are similar between ILM removal and ILM flap surgery, but the ILM flap accelerates recovery.

Purpose: To evaluate macular changes by optical coherence tomography (OCT) following pars plana vitrectomy (PPV) with silicone oil (SO) tamponade in primary rhegmatogenous retinal detachment (RRD). Methods: This prospective interventional study included 50 eyes with recent RRD treated at Beni Suef University Hospital. All patients underwent complete ophthalmological examination, PPV with SO tamponade, and OCT (Optovue RTVue 100 XR Avanti) within two weeks and again at three months postoperatively to assess central macular thickness (CMT) and structural changes. Results: Mean CMT decreased significantly from 261.5 ± 22.1 µm at two weeks to 245.1 ± 40.2 µm at three months (P=0.001). OCT findings included focal photoreceptor loss (12%), intraretinal cysts (10%), atrophic maculopathy (12%), attenuated IS/OS junction (4%), epiretinal membrane (6%), cystoid macular edema (4%), and macular hole (4%). Conclusion: PPV with SO tamponade is a safe and effective option for primary RRD, while OCT provides valuable detection of postoperative complications. Larger multicenter studies are needed to confirm these findings.

PurposeTo evaluate the feasibility and outcomes of a novel surgical technique using a sub-perfluorodecalin (PFD, RT DECALIN) injection of ophthalmic viscosurgical device (OVD) to stabilize inverted internal limiting membrane (ILM) flaps for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes. This technique addresses the challenges of ILM flap displacement and stability.Patients and MethodsThis retrospective, interventional case series included seven eyes of seven patients with MHRD who underwent surgery using sub-PFD injection of OVD to stabilize inverted ILM flaps. Pre- and postoperative best-corrected visual acuity (BCVA) was compared using the Wilcoxon signed-rank test. Ethical approval was obtained, and all patients provided informed consent. Fundus color photography and optical coherence tomography (OCT) were used to assess anatomical outcomes.ResultsThe study included seven eyes of seven patients (mean age: 61.86±4.30 years; follow-up: 6 months). All eyes achieved successful macular hole closure, with near-normal foveal contour observed in five (71.43%) eyes at the final follow-up. BCVA improved significantly from 2.03±0.38 logMAR to 1.20±0.54 logMAR (P = 0.0024). No intraoperative or postoperative complications were observed.ConclusionSub-PFD injection of OVD for stabilization of the inverted ILM flap was feasible and was associated with favorable short-term anatomical outcomes in highly myopic eyes with MHRD. Improvement in BCVA was also observed during follow-up. This innovative approach offers a promising solution to the challenges associated with MHRD in highly myopic eyes.

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

Current and future applications of intraocular bioadhesives in vitreoretinal surgery.

To examine the current landscape of artificial intelligence (AI) applications in vitreoretinal (VR) diseases and surgery, with the aim of identifying knowledge gaps and guiding future directions in this rapidly evolving field. Systematic review including original studies involving the use of AI and focusing on VR pathologies. A comprehensive electronic search of the literature was carried out in multiple databases. Thirty-seven studies were included. Most evaluated machine learning or deep learning models for preoperative prognostication using optical coherence tomography with or without clinical variables. Predictive performance for postoperative best-corrected visual acuity (BCVA) was high in several cohorts (R2 up to 0.80; area under the receiver operating characteristic curve [AUROC] > 0.95), with models consistently highlighting outer retinal biomarkers as key determinants of visual recovery after epiretinal membrane and macular hole surgery. For anatomical outcomes, deep learning models frequently achieved > 90% accuracy in predicting macular hole closure and retinal reattachment/reattachment-related endpoints. Intraoperative computer-vision systems demonstrated feasibility for real-time instrument detection and tracking, reporting precision above 90% in experimental or early clinical settings. Large language models showed moderate-to-high agreement with expert surgical planning (80-93%) and potential utility in education and workflow support; however, across domains, most studies were retrospective and single-center, with limited external validation. AI may transform vitreoretinal surgery, from outcome prediction to intraoperative guidance and workflow support. Despite strong performance in research settings, broader clinical adoption requires prospective validation to ensure reliability, transparency, and real-world benefit.

Recording electroretinograms (ERGs) in eyes with intraocular gas tamponade is difficult, and the mechanism remains unclear. We evaluated the effect of intraocular gas on ERGs by comparing recordings at different body positions. This study included 31 patients who underwent vitrectomy with sulfur hexafluoride (SF6) or air tamponade at Hirosaki University (between May 2023 and October 2024). The patients included those with retinal detachment (25 patients), macular holes (4 patients), and epiretinal membranes (2 patients). ERGs were recorded using skin electrodes when approximately 50% of the vitreous cavity was filled with the intraocular gas. ERGs were recorded in sitting, supine, and face-down positions. Amplitudes and latencies of the LA 3 b-wave and LA 30Hz were compared using the Wilcoxon signed-rank and Friedman tests. In the gas-filled eyes, amplitudes in the face-down position were smaller, and latencies were longer than those in the other positions (p < 0.05). Median amplitudes in the gas-filled eyes in the sitting, supine, and face-down positions were 20.4, 19.5, and 10.1µV for LA 3 and 14.4, 15.5, and 7.11 for LA 30Hz, respectively; median latencies were 32.5, 33.0, and 34.3ms for LA 3 and 30.8, 30.0, and 34.3 for LA 30Hz, respectively. ERG amplitudes were reduced and latencies were prolonged in the face-down position, which may be attributed to a larger retinal area being covered by intraocular gas. The gas acts as an insulator, and the gas-covered retina may not effectively generate or transmit electrical signals.

Purpose The current study aims to evaluate the anatomical and visual outcomes of autologous neurosensory retinal transplantation (ART) in the management of refractory full-thickness macular holes unresponsive to previous vitrectomy with internal limiting membrane peeling. Patients and methods This prospective case series included 20 eyes of 20 patients who underwent pars plana vitrectomy with ART at the Research Institute of Ophthalmology, Egypt, between May 2020 and September 2022. All eyes had previously failed at least one internal limiting membrane peel. A neurosensory retinal graft was harvested from the midperipheral retina and transplanted under perfluoro-n-octane heavy liquid. Anatomical closure was assessed using spectral-domain optical coherence tomography. Visual outcomes were assessed via the best-corrected visual acuity. Results Anatomical closure was achieved in 13 (65%) eyes. In these eyes, mean best-corrected visual acuity significantly improved from 1.58±0.22 logMAR preoperatively to 1.18±0.29 logMAR postoperatively ( P =0.001). Successful restoration of the external limiting membrane and ellipsoid zone was observed, with mean defect lengths decreasing significantly ( P =0.002). Visual improvement of more than or equal to 3 ETDRS lines occurred in 53.8% of eyes with closed holes, and no eye experienced postoperative visual decline. Major complications were retinal detachment in 25% of eyes, graft dislocation (5%), and intractable glaucoma (5%). Conclusion ART represents a valuable salvage technique for refractory full-thickness macular holes, achieving meaningful anatomical closure and visual improvement. Restoration of photoreceptor integrity (external limiting membrane and ellipsoid zone) correlated with visual recovery. Although technically demanding and associated with potential complications, ART offers a promising therapeutic avenue for otherwise untreatable cases. Larger multicenter studies with longer follow-up and standardized surgical protocols are warranted.

Postoperative Epiretinal Membrane After Fovea-sparing Versus Standard Internal Limiting Membrane Peeling for Myopic Traction Maculopathy.

Incidence and risk factors of full-thickness macular hole in fellow eyes.

Relaxing retinectomy and autologous retinal transplant for complex retinal detachment with macular hole: a case series.

Once viewed as an inert transparent medium with no pathophysiological importance, the vitreous body is now recognized as adynamic, cell-regulated compartment with structural, mechanical, biological and immunological functions closely interacting with the retina. Hyalocytes, structural and cellular changes of the vitreous body and the vitreoretinal interface are central to many retinal diseases. Hyalocytes regulate the extracellular matrix and immune response and in cases of dysregulation promote proliferative processes. Structural phenomena, such as vitreoschisis and vitreous cortex remnants act as scaffolds for fibrocellular proliferation. Advances in optical coherence tomography (OCT) now enable a precise in vivo visualization of these mechanisms. This review article summarizes the current knowledge on the structure, cell biology and pathophysiology of the vitreous body, focusing on disorders such as vitreomacular traction (VMT), macular holes, epiretinal gliosis, proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR). A better understanding of these mechanisms opens up new diagnostic and treatment approaches.

The duration of endoillumination is considered a potential risk factor for phototoxic retinal damage during vitreoretinal surgeries. Despite the widespread use of modern lighting systems, clinical data on the effect of endoillumination duration on functional outcomes remain limited. Objective: to evaluate the impact of endoillumination duration on functional outcomes and the safety of vitreoretinal surgery. Patients and methods. The study included patients who underwent vitreoretinal surgeries for macular holes ( n = 31), retinal detachments ( n = 48), and epiretinal membranes ( n = 25). The duration of endoillumination, initial and postoperative bestcorrected visual acuity (BCVA), type of tamponade, and features of the surgical technique were assessed. Statistical analysis involved multivariate regression models to identify determinants of functional outcomes. Results. The duration of endoillumination did not have a statistically significant effect on BCVA at 12 months after surgery ( p &gt; 0.05). Anatomical success was achieved in all cases. Functional outcomes were significantly influenced by initial visual acuity (in the macular hole group), type of tamponade, and performance of combined surgery with phacoemulsification (in the retinal detachment group) ( p &lt; 0.05). No statistically significant factors were identified in the epiretinal membrane group. Conclusion. The obtained results indicate that the duration of endoillumination does not significantly affect the functional outcomes of vitreoretinal surgery, while the primary role remains with the initial anatomical and functional characteristics of the eye and the features of the surgical technique.

This study analyzes the clinical features and surgical outcomes of combat blast-related traumatic full-thickness macular holes (BRTMH) secondary to war-related ocular trauma in Ukraine, managed at a single civilian center. Thirteen patients (14 eyes) with diagnosis of BRTMH treated with pars plana vitrectomy (PPV) were recruited for this retrospective, consecutive case, interventional study. Surgery outcome-related factors including face-down positioning were assessed and statistically analyzed. Blast trauma was the cause of injury in all (100%) of the MH cases, wearing no eye protection. Four eyes (28.6%) with MH were secondary to an open-globe, whereas ten eyes (71.4) were related to a closed-globe injury. MH closure was achieved in all cases (100%) after the primary surgery. The median (IQR) ocular trauma score (OTS) was 68 (56-75), while the time interval from injury to surgery was 41 (19 to 71) days. The median (IQR, interquartile range 25-75%) Minimum Linear Diameters of the MHs (µm) was 682μm (532-889), while nine out of fourteen eyes (64.3%) had BRTMH > 600μm. There was a direct correlation of postoperative visual acuity at 1 month with the OTS score (ρ = 0.51, p = 0.03) and preoperative visual acuity (LogMar) (ρ = 0.72, p = 0.002), and an inverse correlation with the size of the MH (ρ = -0.63 p = 0.008). Combination of different surgical approaches with minimization of postoperative face-down position time allows to achieve high anatomical and functional results being safe and highly acceptable for wounded patients with BRTMH.

Lamellar macular hole (LMH) and epiretinal membrane–foveoschisis (ERM-FS) are distinct subtypes of lamellar macular defects, but clinical differentiation remains challenging. Adaptive optics (AO) and optical coherence tomography angiography (OCTA) may offer novel biomarkers for structural and vascular differences. This study aimed to evaluate photoreceptor integrity and macular microvasculature in LMH and ERM-FS compared with healthy controls. This prospective observational cross-sectional study was conducted at the Department of Ophthalmology, Technical University of Munich, between January 2022 and January 2025. Sixty-one eyes were included: 20 LMH, 21 ERM-FS, and 20 healthy controls. Exclusion criteria were other retinal diseases, high myopia, or prior intraocular surgery except cataract extraction. Best-corrected visual acuity (BCVA), spectral-domain OCT (SD-OCT), OCTA, and AO retinal imaging (rtx1, Imagine Eyes, Orsay, France) were performed. AO-derived metrics included cone density (CD), spacing, regularity, and dispersion. OCTA evaluated foveal and parafoveal vessel density (VD) in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), and choriocapillaris flow. SD-OCT assessed central subfield thickness (CST), central subfield volume (CSV), and outer retinal integrity. Mean [SD] age was 75.7 [7.5] years for LMH, 70.6 [8.7] for ERM-FS, and 71.5 [7.1] for controls. ERM-FS eyes showed increased cone spacing (e.g. at 4° inferior ERM-FS vs. LMH, P = 0.0159, Table 2) and dispersion (e.g. at 4° inferior ERM-FS vs. CG, P = 0.0115, Table 2) compared with LMH and controls, whereas cone density (e.g. at 0° ERM-FS vs. LMH, P =. 0.036, Table 2) and regularity (e.g. at 4° inferior ERM-FS vs. LMH, P = 0.060, Table 2) followed the same direction but did not remain statistically significant after correction for multiple testing. FAZ was larger in LMH than ERM-FS (0.342 vs. 0.236 mm²; P = 0.01). Foveal SCP VD was higher in ERM-FS than LMH and controls (28.16% vs. 22.53% vs. 21.82%; P = 0.01 ERM-FS vs. LMH). LMH eyes more frequently showed ellipsoid zone and external limiting membrane disruptions. ERM-FS was associated with greater CST and CSV. AO and OCTA reveal distinct photoreceptor and vascular alterations in LMH and ERM-FS. LMH is characterized by larger FAZ and more outer retinal disruption, whereas ERM-FS shows increased retinal thickness and more pronounced photoreceptor mosaic disorganization (increased cone spacing/dispersion), with trends toward lower cone density and reduced regularity. Higher foveal SCP VD in ERM-FS may, at least in part, reflect traction-related mechanical effects. Multimodal imaging may enhance diagnostic accuracy and monitoring in lamellar macular defects.