Air versus long-acting gas tamponade for idiopathic macular hole surgery with 24-hour face-down positioning: a bicentric retrospective study.

We compared air and gas tamponade for idiopathic full-thickness macular hole (FTMH) surgery with a 24-hour face-down protocol, in a bicentric, retrospective real-world series of 36 air- and 19 gas-treated eyes. Allocation was non-random (gas predominated earlier, air later). Preoperative symptom duration was short in both groups (median 1 [1-2] months); median hole diameter was 456 [312-611] µm (air) and 497 [364-776] µm (gas; p = 0.40). FTMH closure at 1 month was 100% (36/36) with air and 94.7% (18/19) with gas (p = 0.35), reaching 100% in both groups at 3 and 6 months. Best-corrected visual acuity improved significantly within each group, with no significant between-group difference at any timepoint. No complications occurred with air, whereas peripheral retinal breaks occurred only in the gas group. The air group was younger than the gas group (66.1 vs. 74.4 years; p = 0.018). Air was associated with anatomical and functional outcomes comparable to gas in this cohort; however, the non-random allocation, small sample, absence of a pre-specified margin and limited statistical power preclude any formal non-inferiority conclusion. Air with short positioning appears a practical alternative to gas in sub-acute holes across the size spectrum, warranting prospective confirmation.