INTRODUCTION: This study aimed to investigate postoperative outcomes of minimal gas vitrectomy (MGV) combined with a reduced period of gas-fovea contact in the management of idiopathic full-thickness macular holes (MHs). METHODS: This retrospective cohort study included patients who underwent surgery for MHs with minimal hole diameters of 250-800 µm and categorized them into two groups: conventional fluid-gas exchange (FGX) (38 eyes) and MGV (28 eyes), with FGX replaced by a 1.0-1.2 mL injection of pure sulfur hexafluoride after internal limiting membrane peeling. Postoperatively, patients in the MGV group were kept in a face-down position, switching to face-forward or no positioning (pseudophakia) once MH closure was confirmed by optical coherence tomography, performed every few days during the first postoperative week. The maximum duration of face-down positioning was 5 days. RESULTS: Most baseline characteristics were comparable between the two groups except for the proportion of combined cataract surgery and the use of non-expansile gas, which were higher in the FGX group. Prone positioning time in the MGV group was shorter than that in the control group (3.8 days vs. 11.9 days). Subfoveal fluid pocket was present in 73.0% and 5.2% of eyes in the MGV and FGX groups, respectively. Twenty-seven eyes (96.4%) in the MGV group showed MH closure within 3 months. At 12 months, compared to the FGX group, the MGV group exhibited less disruption of the ellipsoidal zone (28.5% vs. 57.8%), superior visual acuity (0.33 ± 0.18 vs. 0.54 ± 0.28), and comparable MH closure rates. CONCLUSION: In the treatment of medium-sized MHs, when compared to the FGX method, the use of a smaller volume of gas tamponade may be associated with earlier photoreceptor restoration. This method individualized prone positioning period without an immediate impact on central vision post surgery.