Microvascular Factors and Surgical Outcomes in Macular Telangiectasia Type 2-Associated Macular Holes Versus Idiopathic Macular Holes

PURPOSE: Macular holes (MHs) associated with macular telangiectasia (MacTel) type 2 represent a clinically distinct subset in which visual outcomes and surgical responses may differ from those of idiopathic MHs (IMHs); however, their retinal microvascular characteristics remain poorly characterized. This study aimed to clarify these differences by using optical coherence tomography angiography (OCTA). METHODS: This retrospective case-control study was conducted at a tertiary referral center. It included 31 eyes with MacTel type 2-associated MHs and 30 eyes with IMHs that underwent pars plana vitrectomy between March 2017 and October 2025. Retinal microvascular changes were analyzed using OCTA, and quantitative measurements were performed using ImageJ software (version 1.54). RESULTS: Parafoveal superficial vascular plexus vessel density (SVP VD) was significantly lower in MacTel type 2-associated MHs compared with IMHs (31.59±5.61% vs. 42.00±7.21%, p<0.001), with consistent reductions across all quadrants (superior, inferior, temporal, and nasal). No significant differences were observed in deep capillary plexus (DCP) or choriocapillaris parameters between the two groups. In multivariate regression analysis, preoperative visual acuity and MH etiology were independently associated with postoperative visual outcomes (p=0.04 and p<0.001, respectively). Microvascular parameters were not significant predictors. CONCLUSION: MacTel type 2-associated MHs demonstrated significantly reduced SVP VD without corresponding changes in DCP or choriocapillaris, indicating a distinct microvascular profile compared to IMHs. However, SVP VD was not independently associated with short-term postoperative visual outcomes, suggesting that these alterations may reflect disease-specific microvascular characteristics rather than functional determinants of early visual recovery.