- Study Focus: Investigates the correlation between suspended hyperreflective material (SHM) observed in optical coherence tomography (OCT) images and the spontaneous closure of full-thickness macular holes (FTMHs).

- FTMH Characteristics:

  - Anatomical defects in the fovea involving all neural retinal layers, leading to central vision loss.

  - Standard treatment is pars plana vitrectomy (PPV) with membrane peeling, but some FTMHs close spontaneously.

- Objective: To identify predictors of spontaneous FTMH closure using OCT imaging, focusing on SHM and other microstructural features.

- Methods:

  - Retrospective cohort study of patients with FTMHs at Eye and ENT Hospital of Fudan University (2015–2021).

  - Two groups: spontaneous closure group (19 eyes) and surgery-treated control group (37 eyes).

  - Exclusion criteria: traumatic FTMHs, pediatric patients, history of macular diseases, or prior ophthalmic treatments.

  - OCT imaging performed using Stratus OCT or Heidelberg Spectralis SD-OCT.

  - Quantitative analysis of FTMH parameters (e.g., diameter, height, indices like MHI, THI, HFF, DHI).

  - SHM identified as hyperreflective material suspended within FTMHs, classified into dotted, linear, and lumpy types.

  - Reflectivity of intrahole space measured using ImageJ software.

- Results:

  - Demographics: No significant differences in age, axial length, or etiology between groups.

  - FTMH Size: Spontaneously closed FTMHs had smaller minimum diameters (P < 0.0001).

  - VMT: Higher incidence of vitreomacular traction (VMT) in the spontaneous closure group (47.4% vs. 13.5%, P = 0.009).

  - SHM: SHM was more prevalent in the spontaneous closure group (47.4% vs. 8.1%, P = 0.001).

  - Reflectivity: Intrahole reflectivity was significantly higher in the spontaneous closure group (P < 0.0001).

  - Multivariable Analysis: Younger age, smaller FTMH diameter, higher intrahole reflectivity, and SHM presence were positively associated with spontaneous closure.

- Discussion:

  - Spontaneous FTMH closure is rare but may be predicted by smaller hole size, VMT resolution, and SHM presence.

  - SHM may represent glial cell proliferation (e.g., Müller cells, microglia) contributing to hole closure.

  - Limitations include retrospective design, fewer small FTMHs in the control group, and lack of histologic confirmation.

- Conclusion:

  - SHM, smaller FTMH diameter, and VMT are associated with spontaneous FTMH closure.

  - OCT imaging of SHM and intrahole reflectivity may help predict natural healing, potentially avoiding unnecessary surgery.

Figures:

- Figure 2: Shows morphologic types of SHM (dotted, linear, lumpy).