Anatomical Outcomes of Traumatic Macular Hole Surgery: Role of OCT Parameters and ILM Flap Techniques

Background: To evaluate anatomical and functional outcomes following pars plana vitrectomy (PPV) for traumatic macular hole (TMH), investigate optical coherence tomography (OCT)-based prognostic factors, and compare outcomes between flap-based and non-flap internal limiting membrane (ILM) techniques. Methods: This retrospective consecutive case series included 33 eyes of 33 patients undergoing PPV for TMH between January 2017 and June 2024 at a tertiary referral center. Preoperative spectral-domain OCT parameters, including minimum linear diameter (MLD), basal diameter (BD), hole height (HH), intraretinal cysts, subretinal fluid, epiretinal membrane, and ellipsoid zone disruption, were evaluated. Anatomical closure and postoperative best-corrected visual acuity (BCVA) outcomes were analyzed. Results: The mean patient age was 28.7 ± 15.0 years, and blunt trauma accounted for 87.9% of cases. Median trauma-to-surgery interval was 10 weeks (IQR: 4-24 weeks). Mean BCVA improved significantly from 1.34 ± 0.54 logMAR preoperatively to 0.95 ± 0.59 logMAR postoperatively (p = 0.004). Single-surgery anatomical closure was achieved in 28 of 33 eyes (84.8%). Larger MLD and BD were significantly associated with poorer final BCVA, whereas greater HH was associated with successful anatomical closure. Flap-assisted techniques achieved higher closure rates compared with conventional ILM peeling (95.8% vs. 55.6%, p = 0.013). Conclusions: PPV for TMH was associated with favorable anatomical and functional outcomes. Larger hole dimensions were associated with poorer visual prognosis, whereas greater HH was associated with anatomical closure. Flap-assisted ILM techniques may improve anatomical success in TMH surgery.