Predicting visual outcomes after vitrectomy based on baseline visual acuity and timing of surgery for myopic traction...

To evaluate visual outcomes after vitrectomy based on preoperative visual acuity (VA) in eyes with myopic traction maculopathy (MTM) and explore the optimal timing for surgery.

Patients who underwent vitrectomy for MTM were categorized into four groups: preoperative vision of 20/25 or better (V1), worse than 20/25 to 20/50 (V2), 20/60 to 20/200 (V3), and worse than 20/200 (V4). The primary outcome was the postoperative VA at 12 months.

We included 193 eyes: V1 (12 eyes), V2 (77 eyes), V3 (83 eyes), and V4 (21 eyes). Postoperative VA significantly correlated with preoperative VA (R² = 0.400, P < 0.001). Postoperative logarithm of the minimum angle of resolution VA was the best in V1 and worst in V4 (V1, 0.10 ± 0.26; V2, 0.19 ± 0.26; V3, 0.54 ± 0.44; and V4, 0.92 ± 0.54; P < 0.001). Visual improvement was highest in V4 and lowest in V1 (V1, 0.04 ± 0.26; V2, -0.12 ± 0.25; V3, -0.18 ± 0.41; and V4, -0.36 ± 0.44; P = 0.001). At 12 months, 83.3% of eyes in V1 achieved a postoperative VA of 20/25 or better, 90.9% of eyes in V2 achieved 20/50 or better, and 88.0% of eyes in V3 achieved 20/200 or better. Overall, 11.4% of eyes experienced a visual deterioration of three lines or more.

Vitrectomy generally maintains or improves vision in any group. Early surgery may help preserve good vision in eyes with good baseline vision and worsening symptoms; however, the risk of deterioration suggests it may not always be beneficial. Surgery at moderate visual impairment may offer a balanced benefit-risk ratio, avoiding surgery too early or too late.