Influence of posterior staphyloma morphology on macular hole closure patterns in highly myopic eyes

To examine how posterior staphyloma morphology affects macular hole closure patterns in highly myopic eyes.

Retrospective study analysing 188 highly myopic macular holes (MMH) with axial length ≥ 26.5 mm that underwent surgery with either internal limiting membrane (ILM) peeling or inverted flap technique over a 10-year period. Posterior staphylomas were classified as: none, wide macular, narrow macular or peripapillary. Closure patterns were categorized according to Rossi's classification (0A-C, 1A-C, 2A-D). Statistical analysis examined associations between staphyloma types and closure patterns.

ILM peeling and inverted flap showed similar overall anatomical success rates (97.4% vs. 97.3%). Type 1 closure predominated with ILM peeling (97.4% vs. 57.3%), while Type 2 closure was exclusive of ILM inverted flap (40.0%). Staphyloma morphology significantly influenced closure patterns in the ILM inverted flap group. Eyes with wide macular staphyloma had lower odds of Type 2 closure (OR = 0.19, 95% CI: 0.06-0.53, p = 0.002), while the peripapillary one was associated with higher risk (OR = 2.58, 95% CI: 1.13-5.92, p = 0.029). In multivariate analysis, narrow and peripapillary staphylomas remained independent predictors of Type 2 closure. Specific closure subtypes showed distinct associations with staphyloma types: narrow macular with Type 2A closure and peripapillary with Type 2A and 2C closure. Larger MMH (≥400 μm) in eyes with peripapillary staphyloma had the highest rate of Type 2 closure (80.0%).

Posterior staphyloma morphology significantly influences MMH closure patterns in highly myopic eyes, especially with the ILM inverted flap technique. The posterior segment geometry likely affects gas-retina contact during recovery, resulting in different closure patterns.