CLINICAL CHARACTERISTICS AND SURGICAL OUTCOMES OF THE FULL-THICKNESS MACULAR HOLE WITHOUT FOCAL VITREOMACULAR TRACTION: A Multicenter Retrospective Study.

Abstract

This study investigated the clinical features and surgical outcomes of full-thickness macular holes without focal vitreomacular traction (VMT) and discusses possible underlying mechanisms. This retrospective observational study included patients aged 18 years or older with stage 2 full-thickness macular holes who underwent pars plana vitrectomy at three hospitals between December 2016 and March 2024. Patients diagnosed without focal VMT in the macula were classified as VMT- and those with focal VMT were classified as VMT+. Medical records and comprehensive ophthalmologic examinations, including best-corrected visual acuity and optical coherence tomography assessments, were reviewed. This study analyzed 94 eyes that underwent surgery for stage 2 MHs. Patients in the VMT- were younger (VMT- vs. VMT+: 63.6 vs. 69.1 years, P = 0.008), had a longer axial length (25.2 vs. 24.0 mm, P = 0.004), and had better preoperative best-corrected visual acuity [0.41 (20/43) vs. 0.66 (20/74) logarithm of the minimum angle of resolution, P = 0.002] compared with the VMT+. The VMT- had a higher prevalence of epiretinal proliferation compared with the VMT+ (76 vs. 5%, P < 0.001). Postoperatively, no significant difference in visual outcomes was found between the two groups. VMT- showed significantly thicker central retinal thickness at 1 month (244 vs. 201 µ m, P = 0.021) and poorer external limiting membrane status at 1 month compared with the VMT+. Full-thickness macular holes without focal VMT were associated with younger age, longer axial length, better baseline visual acuity, and a higher incidence of epiretinal proliferation compared with full-thickness macular holes with VMT.