Short-term visual acuity responder rates after full-thickness macular hole surgery stratified by hole size: a retrospective cohort study

PURPOSE: To quantify early real-world visual acuity (VA) responder rates at 25-35 days after idiopathic full-thickness macular hole (FTMH) surgery and evaluate the influence of hole size, gas tamponade, and prescribed duration of face-down positioning. METHODS: In this retrospective cohort study, 193 eyes were analyzed after pars plana vitrectomy with internal limiting membrane peeling and SF6 20% or C3F8 12% gas tamponade. Routine Snellen (decimal) best-corrected VA was extracted from the medical record and converted to logarithm of the minimum angle of resolution (logMAR). Primary outcomes were mean VA change from the last preoperative assessment to the postoperative visit at 25-35 days and rates of two and three lines VA improvement (≥ 0.2 and ≥ 0.3 logMAR, respectively). Secondary outcomes were baseline-adjusted postoperative VA and anatomical closure. RESULTS: Overall, 66.8% of eyes improved by ≥ 0.2 logMAR and 52.3% by ≥ 0.3 logMAR. Mean VA improved from 0.774 ± 0.409 to 0.455 ± 0.346 logMAR (mean VA change - 0.318 logMAR; p < 0.001). VA change and responder rates did not differ significantly across International Vitreomacular Traction Study size groups (< 250 μm, 250-400 μm, > 400 μm), and no statistically significant association with gas choice or prescribed face-down positioning duration was detected within the limitations of this retrospective cohort. Baseline-adjusted postoperative VA differed by size, with large holes having worse early postoperative VA than small and medium holes, independent of prescribed face-down positioning duration or vitreomacular traction status. Anatomical closure differed by International Vitreomacular Traction Study size group (small 98.9%, medium 96.7%, large 78.0%; p < 0.001). CONCLUSIONS: In routine care, FTMH surgery results in clinically meaningful early VA improvement at 25-35 days, with approximately two-thirds of eyes gaining ≥ 0.2 logMAR and half gaining ≥ 0.3 logMAR. Although VA improvement was similar across size groups, large holes had lower closure rates and worse early postoperative BCVA. No statistically significant association between gas choice, prescribed face-down positioning duration, and the extent of VA improvement was detected in this retrospective cohort.