Visual outcome after vitrectomy for small idiopathic macular hole: Results from the Small idiopathic MAcuLar hoLe (SMALL) study

Purpose: To investigate visual outcomes after surgery for small idiopathic full-thickness macular holes (FTMHs) exploring associated clinical variables. Methods: Multicentre, retrospective study including eyes with FTMH <= 250 mu m treated with anatomically successful vitrectomy with a 12-month follow-up. The primary outcome was the incidence rate of normal vision outcome, defined as a postoperative best-corrected visual acuity (BCVA) <= 0.1 logMAR and to explore clinical variables associated with it. Rates of suboptimal visual outcome (final BCVA >0.3 logMAR) and intermediate visual outcome (final BCVA >0.1 and <= 0.3 logMAR) were considered as secondary outcomes along with associated clinical variables. Results: Of 539 included eyes, 219 eyes (40.6%) achieved a normal vision outcome. An intermediate visual outcome was shown in 205 eyes (38%) and a suboptimal visual outcome in 115 eyes (21.3%). Vitrectomy with conventional internal limiting membrane (ILM) peeling was performed in 308 eyes (57%), while an inverted flap technique was used in 193 eyes (36%). Thirty-eight eyes (7%) underwent vitrectomy without ILM peeling. Clinical variables associated with normal vision were a better preoperative BCVA and conventional ILM peeling. No ILM peeling vitrectomy proved to be a factor associated with normal vision. Inverted flap technique and a worse preoperative BCVA were associated with suboptimal visual outcome. Conclusion: Surgical treatment of small FTMHs has to be recommended since an excellent final visual outcome has been shown in 40% of cases. Vitrectomy with conventional ILM peeling should be considered the treatment of choice, while the inverted flap technique would not be advisable. Further studies are needed to confirm the role of vitrectomy without ILM peeling.