Intraretinal Hyperreflective Foci as an OCT Feature Associated With Retinal Remodeling After Macular Hole Closure

Purpose: To investigate intraretinal hyperreflective foci (HF) within the foveola in the healing process following surgical closure of full-thickness macular holes (FTMHs), using lamellar macular holes (LMHs) and vitreomacular traction (VMT) as comparisons. Methods: Analysis of spectral-domain optical coherence tomography (OCT) scans from 48 FTMH eyes undergoing surgery was conducted, with 14 LMH and 10 VMT eyes serving as controls. HF were defined as dot-like intraretinal lesions with reflectivity similar to the retinal nerve fiber layer and without back-shadowing, showing a vertical distribution pattern within the foveola. Baseline OCT parameters, including minimal linear diameter, basal diameter, hole height, and macular hole index (MHI), defined as the ratio between hole height and basal diameter, were assessed. HF patterns were evaluated in relation to external limiting membrane (ELM) restoration and ellipsoid zone (EZ) integrity after surgery. Results: Among the 48 FTMH eyes, 43 achieved successful closure (89.6%). HF were identified in all 43 eyes achieving anatomical closure at the first postoperative assessment, compared with 50% in LMH and 50% in VMT controls (P < 0.001). HF preceded complete ELM restoration in nine of 43 eyes (20.9%), whereas in the remaining cases both events were detected simultaneously at the same postoperative visit. At final follow-up, HF persisted in 86.0% of eyes and were associated with baseline larger base diameter (P = 0.044) and baseline lower macular hole index (MHI; P = 0.007). Complete EZ integrity was achieved in 65.1% of eyes and was significantly associated with HF resolution (P = 0.047) and better final visual acuity (P = 0.038). Conclusions: HF displaying a vertical pattern within the foveola may represent an early structural OCT feature associated with retinal remodeling after macular hole surgery. Further studies are needed to determine their biological significance and potential role as an imaging marker of macular hole healing.