Baseline OCT Biomarkers and Early Outcomes After Idiopathic Full-Thickness Macular Hole Surgery: Associations with Primary Failure and Visual Acuity After Successful Closure

Background/Objectives: Baseline visual acuity (VA) and minimum linear diameter (MLD) are well-established predictors after surgery for idiopathic full-thickness macular hole (FTMH). It is less clear whether other optical coherence tomography (OCT) features provide additional information. We examined the associations of selected baseline OCT biomarkers with primary anatomical failure and with early postoperative VA after successful closure. Methods: We retrospectively studied eyes that underwent surgery for idiopathic FTMH at a single Swiss center between 2019 and 2024. Primary failure was assessed exploratorily using Firth penalized logistic regression. Early postoperative VA was analyzed among eyes with successful primary closure and an eligible visit 21–60 days after surgery. Linear regression models included baseline VA and MLD, with each OCT biomarker added separately. Patient-level cluster-robust standard errors accounted for bilateral inclusion. Results: This study included 127 eyes from 124 patients. Primary closure was achieved in 116 eyes (91.3%), while 11 eyes (8.7%) had primary failure. Greater MLD was associated with higher odds of primary failure (odds ratio per 100 µm, 2.09; 95% confidence interval, 1.46–3.26). Among the 99 successfully closed eyes with eligible early follow-up, several OCT biomarkers were associated with postoperative VA in univariable analyses. However, none remained significant after adjustment for baseline VA and MLD and correction for multiple testing. Bumpy borders produced the largest, although modest, improvement in model performance. Conclusions: MLD showed the most consistent exploratory association with primary failure. Additional OCT biomarkers provided limited independent information about early postoperative VA beyond baseline VA and MLD in eyes with successful primary closure and eligible early follow-up.