Aim To present the anatomical and visual outcomes of patients with hypo-reflective cystic defects in outer fovea (outer foveal defect; OFD) in macular holes repaired with non-posturing vitrectomy and short term gas tamponade. To identify the incidence and risk factors for developing OFD foveal defect.

Method A prospective consecutive case series of 58 patients undergoing macular hole surgery was undertaken. OFD detected on 2-week postoperative Optical coherence tomography (OCT) was measured. In these patients OCT was performed monthly until resolution of OCT.

Results 27 eyes (46.6%) had an outer defect at 2 weeks, the presence of which was significantly associated with macular holes with larger base diameters preoperatively (p=0.006). All defects closed spontaneously without further intervention, and the final vision was not affected by the presence of an OFD. Visual recovery was only slightly (and not significantly) delayed by the presence of an outer defect.

Conclusions This is the first study of outcomes of OFDs following macular hole surgery in patients who did not posture postoperatively. OFDs are common but do not adversely affect visual outcomes.