Background: To compare the effects of room air and sulfur hexafluoride (SF6) gas tamponade on functional and morphological macular recovery after vitrectomy for the treatment of idiopathic macular hole (MH). Methods: A total of 22 eyes of 22 patients with preoperative diameter of MH smaller than 500 µm were retrospectively studied. Pars plana vitrectomy with internal limiting membrane peeling was performed, followed by fluid-air exchange with room air or 20% SF6. Surgical outcomes were analyzed, regarding best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography images. Results: The primary closure rate was 100% in both groups, while there was a statistically significant difference in the prone posturing period between the SF6 group (7.0 ± 1.6 days) and the air group (3.7 ± 0.6 days; p < 0.0001, unpaired t test). Mean BCVA at baseline, month 1 and month 3 was 0.25, 0.63 and 0.77 in decimal units in the SF6 group and 0.32, 0.60 and 0.73 in the air group, respectively. Conclusions: This study suggests that room air tamponade may provide equally prompt functional and morphological recovery as well as a comparable rate of MH closure with even a shorter prone posturing period compared with SF6 gas tamponade, at least for MH with relatively small diameters.

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