Clinical Characteristics and Surgical Outcomes of the Full-thickness Macular Hole Without Focal Vitreomacular Traction: A Multicenter Retrospective Study

Purpose: This study investigated the clinical features and surgical outcomes of full-thickness macular holes (FTMHs) without focal vitreomacular traction (VMT) and discusses possible underlying mechanisms. Methods: This was a retrospective observational study included patients aged 18 years or older with stage 2 FTMHs 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 (BCVA) and optical coherence tomography assessments, were reviewed. Results: 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 (AL) (25.2 vs 24.0 mm, P = 0.004), and had better preoperative BCVA [0.41 (20/43) vs 0.66 (20/74) logMAR, P = 0.002 ] compared with the VMT+. The VMT– had a higher prevalence of epiretinal proliferation (EP) 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 μm, P = 0.021) and poorer external limiting membrane status at 1 month compared with the VMT+. Conclusions: FTMHs without focal VMT were associated with younger age, longer AL, better baseline visual acuity, and a higher incidence of EP compared with FTMHs with VMT.