Visual and anatomical outcomes of full-thickness macular hole surgery and associated factors in selected hospitals in Tanzania

Purpose To determine the anatomical and visual outcomes of macular hole surgery and identify factors associated with surgical success among patients at Kilimanjaro Christian Medical Centre (KCMC) and Comprehensive Community-Based Rehabilitation Hospital (CCBRT), Tanzania. Methods We conducted a retrospective cohort study between August and December 2023. Data on demographics, pre- and postoperative clinical characteristics, surgical details, and outcomes were extracted from medical records using a structured data collection tool. Analyses were performed using SPSS version 27. The Friedman test was used to compare median pre- and postoperative visual acuity (VA). Generalized estimating equations with logistic regression assessed factors associated with macular hole closure, while gamma regression modelled postoperative logMAR VA, accounting for repeated measures. Statistical significance was set at p < 0.05. Ethical approval was obtained from the Institutional Review Board, and patient data were handled confidentially. Results A total of 101 eyes were analysed, of which all had idiopathic macular holes. Preoperatively, the median logMAR VA was 1.2(Snellen 6/96). At three months, median VA improved to 1.00(Snellen 6/60), representing a gain of 0.20 logMAR (approximately two ETDRS lines; p < 0.001). Anatomical closure was achieved in 70% of eyes. Multivariable analysis showed that good preoperative VA increased the odds of macula hole closure (aOR 19.77; 95% CI 1.20–25.3; p = 0.037). The use of the conventional ILM flap technique was associated with an increase in logMAR VA (aβ = 0.05, 95% CI 0.01–0.08, p = 0.012). Anatomical closure correlated with significant visual improvement (p < 0.001). Effect sizes for VA changes were modest, reflecting limited but meaningful functional gain. Conclusion Over two-thirds of eyes achieved anatomical closure with modest visual improvement. These findings confirm the effectiveness of macular hole surgery in resource-limited settings. Expanding surgical capacity and applying evidence-based techniques could further improve outcomes. Longer-term follow-up with optical coherence tomography is recommended to optimize treatment strategies and patient counselling.