Outcomes of Vitrectomy with 50% Fluid–Air Exchange for Idiopathic Macular Hole

Background/Objectives: Vitrectomy with gas tamponade is the standard treatment for idiopathic macular hole (MH); however, prolonged facedown positioning (FD) and delayed postoperative assessment of MH closure may increase patient burden. This study aimed to evaluate the anatomical and functional outcomes of vitrectomy with 50% fluid–air exchange for idiopathic MH, with particular emphasis on the feasibility of early postoperative OCT assessment and individualized postoperative management. Methods: This retrospective study included 22 eyes from 19 patients who underwent 27-gauge pars plana vitrectomy with internal limiting membrane peeling and 50% fluid–air exchange for idiopathic MH between April 2019 and January 2025. MH closure was evaluated postoperatively using spectral-domain optical coherence tomography (OCT), and FD was discontinued once closure was confirmed. The primary outcome was the MH closure rate. Secondary outcomes included time to closure, changes in best-corrected visual acuity (BCVA), and complications. Results: Primary MH closure was achieved in 20 of 22 eyes (90.9%). The mean time to closure was 1.7 days, and closure was confirmed on postoperative day 1 in 14 eyes (64%). MH status was successfully evaluated using conventional SD-OCT in all 22 eyes (100%), and no eye required swept-source OCT imaging. Two eyes required reoperation with complete fluid–air exchange, after which both achieved closure. Mean BCVA improved significantly from 0.45 ± 0.30 logMAR preoperatively to 0.15 ± 0.31 logMAR postoperatively (p < 0.001). No severe intraoperative or postoperative complications, including retinal detachment or endophthalmitis, were observed. Conclusions: Vitrectomy with 50% fluid–air exchange enabled early postoperative assessment of MH status using conventional SD-OCT and facilitated individualized management of facedown positioning. Further prospective comparative studies are warranted to define its role in contemporary MH surgery.