Clinical and Optical Coherence Tomography Characteristics of Large Primary Macular Holes

Abstract

Large primary full-thickness macular holes are associated with visual impairment and complex optical coherence tomography (OCT) abnormalities. This single-center cross-sectional study described pretreatment clinical and OCT characteristics of large primary macular holes and explored associations with symptom duration and visual acuity. Forty eyes from 40 surgical candidates with primary macular holes and a minimum linear diameter (MLD) > 400 µm were analyzed at Vietnam National Eye Hospital, Hanoi, Vietnam, from March to December 2025. Clinical variables included age, sex, symptom duration, and best-corrected visual acuity (BCVA). OCT variables included vitreomacular status, fluid cuff, intraretinal cyst severity, MLD, base diameter, hole height, external limiting membrane (ELM) and ellipsoid zone (EZ) defect lengths, macular thickness parameters, and macular hole indices. Mean age was 63.7 ± 8.4 years, and women accounted for 57.5% of patients. Mean BCVA was 1.47 ± 0.44 logMAR. Mean MLD, base diameter, and hole height were 594.3 ± 155.8 µm, 1234.9 ± 456.3 µm, and 480.3 ± 110.4 µm, respectively. Complete posterior vitreous detachment, fluid cuff, and intraretinal cysts of any severity were observed in 77.5%, 57.5%, and 85.0% of eyes, respectively. Longer symptom duration was associated with larger MLD and lower HFF and THI. Poorer BCVA was associated with larger MLD and lower MHI and THI. Outer retinal defect lengths correlated with hole size, and fluid cuff was associated with wider structural disruption. Comprehensive pretreatment OCT assessment helps characterize structural severity in large primary macular holes. These associations are exploratory and should be validated prospectively.