Anatomical and functional outcomes of different surgical approaches for persistent macular holes

Abstract Background To evaluate the anatomical and visual outcomes of different surgical techniques for persistent macular holes (PMHs) and to identify factors associated with postoperative visual outcomes. Methods This retrospective study included 36 eyes with PMHs undergoing secondary surgery, including MH edge massage, internal limiting membrane (ILM) flap technique, and human amniotic membrane (hAM) transplantation. Anatomical closure, outer retinal integrity, and BCVA were assessed. Factors associated with final BCVA were analyzed. Results The overall closure rate was 83.3%. In the massage group, Type I closure was achieved in 78.6% of eyes, and BCVA improved significantly in eyes with successful closure ( P = 0.028), with 54.5% gaining ≥ 2 lines. In the ILM flap group, Type I closure rates were 85.7% and 87.5% in the covering and insertion subgroups, respectively, with significant BCVA improvement in both. Among successfully closed eyes, ≥ 2-line BCVA gains were observed in 100% and 71.4%, respectively. In the hAM group, the Type I closure rate was 85.7%, with significant BCVA improvement ( P = 0.027), and all successfully closed eyes (100%) achieved ≥ 2-line BCVA gains. Multivariate analysis identified follow-up duration ( P = 0.003), and external limiting membrane integrity ( P < 0.001) as independent factors associated with final BCVA. Conclusions ILM flap techniques, hAM transplantation, and retinal massage may represent feasible surgical options for selected PMHs. Because direct comparisons among surgical techniques were not feasible in this study, the findings may provide clinicians with practical considerations when selecting a surgical approach according to individual clinical and intraoperative circumstances.