Surgical Management and Outcomes of Large High Myopic Macular Holes: Global Macular Hole Multicenter Study 3

Purpose: To characterize the surgical management and outcomes of large high myopic macular holes (HMMHs). Methods: Global multicenter retrospective case series of HMMHs with minimum linear diameter (MLD) ≥ 400 μm undergoing surgery between 2013-2023 with follow up ≥ 3 months. The main outcome measure was the HMMH closure rate at postoperative month 3. Results: 499 cases of 463 patients from 37 surgeons were included, with mean ± SD age 58.3 ± 12.2 years, 77.0% female, 77.4% primary, 22.6% refractory, and mean ± SD follow-up 18.8 ± 20.2 months. The mean ± SD (range) MLD was 649 ± 280 (400, 2759) µm. Surgery techniques included 127 internal limiting membrane (ILM) peels, 285 ILM flaps, 19 amniotic membrane transplantations (AMT), 36 autologous retinal transplantations (ART), and 32 others. The postoperative month 3 closure rate for all cases was 72.4%. Closure rates significantly decreased with greater CLOSE Study Group size classification for HMMHs treated with ILM peeling or ILM flap (P = 0.006) but not for HMMHs treated with AMT or ART (P > 0.05). Visual acuity (VA) significantly increased from baseline to each follow-up time point among all eyes, with final mean ± SD change in VA of -0.29 (0.55) logMAR (+14.5 ETDRS letters), which did not significantly differ by surgery type. Conclusion: HMMH closure rates are lower than those reported for macular holes in non-highly myopic eyes, but most eyes can still achieve anatomic closure and meaningful VA gains when treated with the appropriate technique.