Dyslipidemia May Delay Macular Hole Closure After Surgery

Dyslipidemia may be associated with delayed macular hole (MH) closure, indicating a possible role of systemic metabolic dysfunction in postoperative retinal recovery.1

Idiopathic MH is distinguished by a full-thickness defect with the neurosensory retina in the center of the fovea or macula. It can result in visual impairments, such as decreased central vision, metamorphopsia, or central scotoma. MH formation generally progresses over several weeks to several months.2

The standard surgical technique for MH currently involves pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, intravitreal gas tamponade, and postoperative facedown positioning. This standardized procedure allows >90% of MHs to achieve anatomical closure with improved visual function. However, despite achieving high closure rate, MHs often exhibit persistent difficulty in closing; primary factors influencing this include MH size, duration, ILM peeling adequacy, gas tamponade sufficiency, and postoperative positioning compliance. Recent studies have also suggested dyslipidemia as an indirect contributor to MH healing.1

“The majority of research conducted on MHs has primarily concentrated on the treatment strategy involving their closure. Relatively few studies have focused on the factors associated with the healing time of MHs,” Jingwen Hui, Tianjin Eye Hospital, and colleagues wrote. “Consequently, our objective was to undertake a comprehensive statistical analysis of the proportion and durations of delayed MH healing, as well as its impact on the recovery of postoperative defect structure and visual function.”1

Hui and colleagues initially collected patients from Tianjin Eye Hospital who were diagnosed and treated for MH between 2015 and 2024. To be included in the study, patients were required to be aged 18-80 years, have clinically diagnosed idiopathic MH confirmed by OCT, have undergone primary MH surgery with ILM flap technique, and have completed pre- and postoperative data and ≥1 month follow-up. Patients were excluded if they had a history of ocular trauma, severe visual impairment unrelated to MH, other significant retinal or optic nerve diseases, or incomplete follow-up data.1

A total of 432 patients were included in the study, with 372 individuals exhibiting anatomical MH closure within 2 weeks post-surgery and 60 without closure within 2 weeks. Investigators used multivariate regression analysis to determine associations between total cholesterol (TC), triglycerides (TG), and delayed healing after MH surgery.1

Ultimately, the team found a significant association between MH healing and TC (1.37; 95% CI, 1.06-1.80; P = .0205), as well as between MH healing and TG (1.25; 95% CI, 1.01-1.58; P = .0481). Moreover, after adjusting for gender, age, and race variables, these positive correlations increased (TC: 1.46; 95% CI, 1.11-1.92; P = .0075; TG: 1.26; 95% CI, 1-1.59; P = .0492).1

Hui and colleagues did, however, highlight some limitations, such as the study’s retrospective nature, which may generate inherent selection bias. Additionally, retrospective studies cannot establish causality between dyslipidemia and delayed MH healing. Lack of long-term follow-up data also limits insights into prolonged postoperative outcomes, and investigators may have failed to account for potential confounding metabolic conditions such as diabetes and hypertension.1

“Further studies are needed to elucidate the precise molecular mechanisms linking dyslipidemia to retinal wound healing,” Hui and colleagues wrote. “Prospective clinical trials investigating the impact of lipid-lowering interventions on MH surgical outcomes will be crucial. Additionally, exploring genetic predispositions related to lipid metabolism and retinal repair may help refine individualized treatment strategies.”1

References

1. Hui J, Zhou Y, Han Q, Wang Y. Dyslipidemia for delayed healing after macular hole surgery: a clinical risk analysis study. BMC Ophthalmol. 2025;25(1):577. Published 2025 Oct 15. doi:10.1186/s12886-025-04414-z

2. Flaxel CJ, Adelman RA, Bailey ST, et al. Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology. 2020;127(2):P184-P222. doi:10.1016/j.ophtha.2019.09.026