LAUSR

PURPOSE To investigate the clinical characteristics and surgical outcomes of stage 4 macular holes (MHs) with epiretinal proliferation (EP) and explore the pathogenesis of MH formation. METHODS This retrospective study included consecutive patients who underwent pars plana vitrectomy for stage 4 MH. Patients were divided into two groups based on the presence or absence of EP. Baseline characteristics, optical coherence tomography (OCT) features of MHs, and surgical outcomes were compared between the groups. RESULTS EP was detected in 31 of 102 eyes with stage 4 MH (30%). Patients with EP were older (p = 0.044), predominantly male (p = 0.047), had a greater axial length (p = 0.008), and had better preoperative visual acuity (p < 0.001) than those without EP. On OCT, eyes with EP had more epiretinal membrane and intraretinal splitting (p = 0.002 and p < 0.001, respectively) than those without EP. The hole closure rate after primary surgery was comparable, and visual acuity at 6 months after surgery was significantly better in eyes with EP than those without EP (p = 0.036). In 9 eyes with EP, the medical record documented the presence of complete posterior vitreous detachment before MH development. CONCLUSION Patients of stage 4 MH with EP were older, predominantly male, and had better pre- and postoperative visual acuity compared with those without EP. The differences in demographic characteristics and OCT findings suggest that the pathogenesis of stage 4 MH with EP is different from that of stage 4 MH without EP.