Anatomical and functional outcomes and prognostic factors after idiopathic full-thickness macular hole surgery: a single-center retrospective cohort study

Abstract

To evaluate anatomical and functional outcomes after idiopathic full-thickness macular hole (FTMH) surgery and identify factors associated with anatomical closure and six-month visual outcome. This retrospective study included 74 eyes of 74 patients who underwent primary pars plana vitrectomy (PPV) between June 2014 and November 2025. Surgery was performed with either conventional internal limiting membrane (ILM) peeling or temporal inverted ILM flap surgery. Baseline clinical data, optical coherence tomography (OCT) parameters, including minimum linear diameter (MLD) and macular hole index (MHI), tamponade type, anatomical outcomes, reoperation status, and best-corrected visual acuity (BCVA) were analyzed. Primary anatomical closure was defined as closure after the initial surgery, whereas final anatomical closure was defined as closure at final follow-up, including closure after reoperation. An exploratory adjusted linear regression model evaluated factors associated with six-month BCVA. Primary anatomical closure was achieved in 59 eyes (79.7%), and final anatomical closure increased to 64 eyes (86.5%) after reoperation. Median BCVA improved from 1.30 to 0.70 logMAR at postoperative months 3 and 6 (both p < 0.001). Reoperation was performed in 9 eyes with persistent macular hole and achieved closure in 5 eyes (55.6%). Poorer preoperative BCVA was associated with persistent anatomical failure after primary surgery and at final follow-up (p = 0.021 and p = 0.023). Primary surgical technique, MLD category, and MHI category were not associated with anatomical closure. Although eyes treated with temporal inverted ILM flap surgery had poorer preoperative BCVA and a numerically larger MLD, six-month BCVA gain was greater in these eyes in the unadjusted comparison (p = 0.036). However, after adjustment for preoperative BCVA and MLD, surgical technique was not independently associated with six-month postoperative BCVA (p = 0.155). Better preoperative BCVA and smaller MLD were associated with better six-month postoperative BCVA (p = 0.001 and p = 0.021). Surgery achieved anatomical closure in most eyes and significant six-month visual improvement. Baseline visual acuity and MLD may be clinically relevant markers of postoperative outcome, whereas the apparent unadjusted visual benefit of temporal inverted ILM flap surgery should be interpreted cautiously.