SURGICAL MANAGEMENT AND OUTCOMES OF LARGE HIGH MYOPIC MACULAR HOLES

Purpose: To characterize the surgical management and outcomes of large high myopic macular holes (HMMHs). Methods: Global multicenter retrospective case series of HMMHs with minimum linear diameter ≥ 400 µ m undergoing surgery between 2013 and 2023 with follow-up ≥ 3 months. The main outcome measure was the HMMH closure rate at postoperative Month 3. Results: Four hundred and ninety-nine cases of 463 patients from 37 surgeons were included, with mean ± SD age 58.3 ± 12.2 years, 77.0% female, 77.4% primary, 22.6% refractory, and mean ± SD follow-up 18.8 ± 20.2 months. The mean ± SD (range) minimum linear diameter was 649 ± 280 (400, 2,759) µ m. Surgery techniques included 127 internal limiting membrane peels, 285 internal limiting membrane flaps, 19 amniotic membrane transplantations, 36 autologous retinal transplantations, and 32 others. The postoperative Month 3 closure rate for all cases was 72.4%. Closure rates significantly decreased with greater CLOSE Study Group size classification for HMMHs treated with internal limiting membrane peeling or internal limiting membrane flap ( P = 0.006) but not for HMMHs treated with amniotic membrane transplantations or autologous retinal transplantations ( P > 0.05). Visual acuity significantly increased from baseline to each follow-up time point among all eyes, with a final mean ± SD change in visual acuity of -0.29 (0.55) logMAR (+14.5 early treatment diabetic retinopathy study letters), which did not significantly differ by surgery type. Conclusion: High myopic macular hole closure rates are lower than those reported for macular holes in nonhighly myopic eyes, but most eyes can still achieve anatomical closure and meaningful visual acuity gains when treated with the appropriate technique.