Cellular-Scale Photoreceptor Remodeling After Macular Hole Surgery Examined by Adaptive Optics Optical Coherence Tomography

Purpose: To investigate outer retinal remodeling at the cellular level after macular hole (MH) surgery using adaptive optics optical coherence tomography (AO-OCT) and to assess the potential clinical relevance of transient hyper-reflective bodies (HRBs) newly observed within the outer nuclear layer (ONL). Methods: High-resolution AO-OCT was used to longitudinally assess the outer retinal microstructure in 12 eyes from 11 patients with idiopathic MH who underwent successful vitrectomy. The integrity of the photoreceptor inner segment (IS), outer segment (OS), ellipsoid zone, visibility of photoreceptor nuclei in the ONL, and the presence and positional changes of discrete HRBs were evaluated. Results: All eyes exhibited IS and OS disruptions, focal loss of photoreceptor nuclei, and transient HRBs within the ONL during the early postoperative phase. By the late phase, photoreceptor nuclei reappeared in all eyes, and local restoration of the IS, OS, and ellipsoid zone occurred. The HRB counts decreased over time. The normalized HRB-ELM distances were significantly shorter in the late phase than in the early phase. Conclusions: This study provides in vivo cellular-resolution evidence for stepwise outer retinal remodeling following MH surgery. Recovery of the photoreceptor segments occurred specifically beneath the reappearing photoreceptor nuclear signals, indicating localized reorganization rather than passive displacement. Transient HRBs diminished in parallel with structural recovery and may represent intermediate stages of retinal remodeling. In conjunction with photoreceptor integrity, HRBs could serve as dynamic indicators of outer retinal repair in vivo.