Influence of posterior staphyloma morphology on macular hole closure patterns in highly myopic eyes

PURPOSE: To examine how posterior staphyloma morphology affects macular hole closure patterns in highly myopic eyes. METHODS: Retrospective study analysing 188 highly myopic macular holes (MMH) with axial length ≥ 26.5 mm that underwent surgery with either internal limiting membrane (ILM) peeling or inverted flap technique over a 10-year period. Posterior staphylomas were classified as: none, wide macular, narrow macular or peripapillary. Closure patterns were categorized according to Rossi's classification (0A-C, 1A-C, 2A-D). Statistical analysis examined associations between staphyloma types and closure patterns. RESULTS: ILM peeling and inverted flap showed similar overall anatomical success rates (97.4% vs. 97.3%). Type 1 closure predominated with ILM peeling (97.4% vs. 57.3%), while Type 2 closure was exclusive of ILM inverted flap (40.0%). Staphyloma morphology significantly influenced closure patterns in the ILM inverted flap group. Eyes with wide macular staphyloma had lower odds of Type 2 closure (OR = 0.19, 95% CI: 0.06-0.53, p = 0.002), while the peripapillary one was associated with higher risk (OR = 2.58, 95% CI: 1.13-5.92, p = 0.029). In multivariate analysis, narrow and peripapillary staphylomas remained independent predictors of Type 2 closure. Specific closure subtypes showed distinct associations with staphyloma types: narrow macular with Type 2A closure and peripapillary with Type 2A and 2C closure. Larger MMH (≥400 μm) in eyes with peripapillary staphyloma had the highest rate of Type 2 closure (80.0%). CONCLUSION: Posterior staphyloma morphology significantly influences MMH closure patterns in highly myopic eyes, especially with the ILM inverted flap technique. The posterior segment geometry likely affects gas-retina contact during recovery, resulting in different closure patterns.