Phacovitrectomy vs. consecutive vitrectomy for idiopathic macular holes: short and long-term outcomes and OCT image quality assessment

Purpose: To compare short- and long-term anatomical, functional, and refractive outcomes between combined phacovitrectomy (PVS) and consecutive vitrectomy (CVS) for idiopathic macular holes (MHs). Also, to evaluate the role of preoperative optical coherence tomography (OCT) image quality in guiding surgical selection.

Methods: This retrospective study analyzed 183 phakic MH eyes operated between 2012 and 23, with patients divided into PVS and CVS groups. Demographic and ocular data, MH features, visual acuity (VA), refraction changes and postoperative outcomes, and follow-up details were collected. Pre- and post-operative OCT scans were evaluated for MH characteristics, OCT image quality, and surgical outcomes at short-term (≤ 3 months) and long-term (≥ 5 years) intervals.

Results: The study included 144 eyes in PVS group and 39 in CVS group. Median follow-up duration was 16 months for PVS group and 72 months for CVS group (p < 0.001). Both groups showed significant VA improvements and comparable MH closure rates at short-term follow-up. However, CVS group had significantly better postoperative VA at short-term (p = 0.001) and long-term (p = 0.017) intervals. The preoperative OCT quality index did not significantly differ between groups and was ineffective in assessing cataract grade or guiding surgical decisions. Both groups experienced a myopic refractive shift, with a higher magnitude in the PVS group (p = 0.04). Postoperative complications were similar between the groups.

Conclusion: CVS achieves better long-term VA than PVS following MH repair, despite similar anatomical outcomes. Preoperative OCT quality index is not effective for guiding surgical decisions, and careful refractive planning is essential, especially for PVS patients, to address postoperative myopic shifts.

Clinical trial registration number: Not applicable.