PROGNOSTIC FACTORS FOR SECONDARY MACULAR HOLE DEVELOPMENT AFTER SURGERY FOR FOVEA-OFF RHEGMATOGENOUS RETINAL...

To evaluate independent preoperative risk factors for secondary macular hole (MH) after fovea-off rhegmatogenous retinal detachment (RRD) and their impact on postoperative visual outcomes.

This retrospective study included fovea-off RRD patients with preoperative optical coherence tomography (OCT) confirmed subfoveal fluid and complete pre- and postoperative demographics, clinical features, and OCT images. Based on postoperative OCT images, patients were subdivided into No MH, lamellar MH, and full-thickness MH groups after RRD surgery. Multivariate logistic regression and linear regression were applied to identify the factors associated with postoperative secondary MH and best-corrected visual acuity, respectively.

Of these 705 patients, 57 developed secondary MH after RRD surgery, whereas the remaining 648 patients served as the control group. Multivariate logistic regression analysis demonstrated that Müller cell cone (MCC) loss (OR = 4.401, P = 0.001), bacillary layer detachment (OR = 2.528, P = 0.041), retinal detachment (RD) extent (OR = 1.136, P = 0.031), and foveal neurosensory thickness (OR = 0.992, P = 0.030) were independent MH risk factors. Multiple linear regression analysis showed that MCC loss (β = 0.308, P < 0.001), greater RD extent (β = 0.024, P = 0.010), longer RD duration (β = 0.001, P = 0.036), outer nuclear layer thinning (β = 0.144, P = 0.001), and worse preoperative best-corrected visual acuity (β = 0.129, P < 0.001) predicted poorer visual outcomes.

MCC loss is the strongest risk factor for both MH development and worse visual prognosis after RRD surgery.