Methods: A retrospective single-centre review was conducted of consecutive MH repairs performed between January 2015 and August 2025. All 583 eyes underwent 25-gauge pars plana vitrectomy with an inverted internal limiting membrane (ILM) flap and 20% SF6 endotamponade. RAO was observed in 5 patients. Collected variables included best-corrected visual acuity, intraocular pressure (IOP), RAO subtype and time to onset, and OCT and OCTA parameters.

Results: RAO subtypes were CRAO in three eyes and CLRAO in two. Onset occurred within 24 hours in two cases, on day 15 in one case, and on day 30 in two cases. MH closure was achieved in four of five eyes. Central macular thickness decreased from 261.5 ± 61.3 µm to 168.2 ± 36.6 µm (p < 0.001). The foveal avascular zone was larger in RAO eyes than in the fellow eye (589.32 ± 154.1 µm² vs 317.29 ± 171.2 µm², p < 0.001). Superficial and deep plexus vessel densities were lower in RAO eyes at one month, with no significant interocular differences (all p > 0.05).

Conclusions: RAO after MH surgery is rare but vision-threatening. The pathogenesis appears multifactorial and may involve periocular anaesthesia, procedure-related haemodynamics (infusion pressure and gas expansion), and patient vascular risk. Preoperative risk optimisation, careful titration of intraoperative parameters, minimally traumatic ILM peeling, and early postoperative monitoring with IOP and OCT/OCTA are prudent. Prospective multicentre studies are needed. Keywords : macular hole; optical coherence tomography angiography; pars plana vitrectomy; retinal artery occlusion