To analyze the recovery course of foveal microstructures and evaluate the important structures for visual improvement after vitrectomy for full thickness macular hole (MH) using optical coherence tomography (OCT).

We retrospectively reviewed the medical records of 34 cases with idiopathic macular hole. We investigated the healing process of foveal microstructures and visual acuity pre- and post-operatively at 1, 3, 6, 12 months after surgery. We evaluated the integrity of four factors by OCT image: existence of MH (Hole, H_1,3,6,12), recovery of outer nuclear layer (ONL, O_1,3,6,12), recovery of external limiting membrane (ELM, E_1,3,6,12), and recovery of inner segment-outer segment (IS/OS) line of the photoreceptor (Photoreceptor, P_1,3,6,12). We compared the recovery course and visual acuity of the four groups based on postoperative 12 months.

The mean observed period was 1.85 ± 2.59 months at recovery of ONL, 3.78 ± 3.83 months at recovery of ONL and ELM, and 7.40 ± 3.56 months at recovery of ONL, ELM and IS/OS line. At postoperative 12 months, the best corrected visual acuity (BCVA) of Groups E and P were better than that of Groups H and O ( p < 0.05). Except for group H, all groups had improved BCVA at postoperative 12 months compared to preoperative BCVA ( p < 0.05).

Recovery sequences of foveal microstructures were ONL, ELM and IS/OS line after vitrectomy for idiopathic MH. The most important structures for visual acuity were restorations of both ELM and IS/OS line.