PROGNOSTIC FACTORS FOR SECONDARY MACULAR HOLE DEVELOPMENT FOLLOWING SURGERY FOR FOVEA-OFF RHEGMATOGENOUS RETINAL DETACHMENT AND POST-OPERATIVE VISUAL OUTCOMES

Purpose: To evaluate independent pre-operative risk factors for secondary macular hole (MH) following fovea-off rhegmatogenous retinal detachment (RRD) and their impact on post-operative visual outcomes. Methods: This retrospective study included fovea-off RRD patients with pre-operative optical coherence tomography (OCT) confirmed sub-foveal fluid and complete pre- and post-operative demographics, clinical features, and OCT images. Based on post-operative OCT images, patients were subdivided into No MH, lamellar MH, and full-thickness MH groups after RRD surgery. Multivariate logistic regression and linear regression were applied to identify the factors associated with post-operative secondary MH and best-corrected visual acuity (BCVA) respectively. Results: Of these 705 patients, 57 developed secondary MH after RRD surgery, while the remaining 648 patients served as the control group. Multivariate logistic regression analysis demonstrated that Müller cell cone (MCC) loss (OR = 4.401, P = 0.001), bacillary layer detachment (OR = 2.528, P = 0.041), retinal detachment (RD) extent (OR = 1.136, P = 0.031), and foveal neurosensory thickness (OR = 0.992, P = 0.030) were independent MH risk factors. Multiple linear regression analysis showed that MCC loss (β = 0.308, P < 0.001), greater RD extent (β = 0.024, P = 0.010), longer RD duration (β = 0.001, P = 0.036), outer nuclear layer thinning (β = 0.144, P = 0.001), and worse pre-operative BCVA (β = 0.129, P < 0.001) predicted poorer visual outcomes. Conclusion: MCC loss is the strongest risk factor for both MH development and worse visual prognosis after RRD surgery.