Background characteristics
Patient background characteristics are presented below. In the Good group, there were 17 males and 20 females, and the mean age was 64.1 years. The Moderate group was comprised of 13 males and 22 females, with a mean age of 66.7 years. In the Good and Moderate groups, 11 and 9 eyes presented with pseudo-macular hole configuration, respectively. There were no significant differences in sex, age, or percentage of pseudo-macular holes between the two groups (Table 1). In the Good and Moderate groups, two and one eye, respectively, had already undergone IOL implantation. In the Good group, one eye had been treated with lens sparing vitrectomy.
No postoperative complications such as vitreous hemorrhage, retinal detachment, endophthalmitis, visual field loss, cystoid macular edema, and cataract progression were reported.
BCVA
In the Good group, the average preoperative BCVA was logMAR −0.09 and averages of postoperative BCVA were logMAR −0.12 at post-3 M, −0.13 at post-6 M, and −0.13 at post-12 M, indicating significant improvement at each time point (P = 0.02, P = 0.01, and P = 0.01, respectively). In the Moderate group, the average preoperative BCVA was logMAR 0.23 and averages of postoperative BCVA were logMAR −0.01 at post-3 M and −0.06 at post-6 M, indicating significant improvement at both time points (both P < 0.0001). In the Good group as compared with the Moderate group, significantly better BCVA was demonstrated preoperatively, and at post-3 M, and post-6 M (P < 0.0001, P < 0.0001, and P = 0.003, respectively), as shown in Table 2 and Fig. 1).
Horizontal metamorphopsia scores
Investigation of MH indicated that in the Good group, as compared with the preoperative score of 0.84°, the postoperative scores were 0.52° at post-1 M, 0.44° at post-3 M, 0.45° at post-6 M, and 0.37° at post-12 M, indicating significant improvement at each time point (P = 0.0003, P < 0.0001, P < 0.0001, and P < 0.0001, respectively). In the Moderate group, as compared with the preoperative score of 0.87°, MH was 0.86° at post-3M and 0.71° at post-6M, indicating significant improvement (P = 0.015 and P < 0.0001, respectively; Table 2, Fig. 2). However, there were no significant differences between two groups at post-3M and post-6M.
Vertical metamorphopsia scores
Investigation of MV indicated that in the Good group, as compared with the preoperative of 0.86°, the post-1 M, post-3 M, post-6 M, and post-12 M scores were 0.57°, 0.66°, 0.62°, and 0.77°, respectively, indicating significant improvement at post-1 M, 3 M, and 6 M (P = 0.0006, P = 0.048, and P = 0.018, respectively). However, there was no significant improvement at post-12 M (P = 0.38). In the Moderate group, compared with the preoperative score of 0.79°, MV was 0.48° at post-3M and 0.59° at post-6 M, indicating significant improvement at post-3 M (P = 0.004). However, no significant improvement was seen at post-6 M (P = 0.06). Neither group showed any significant differences preoperatively or at post-3 M and post-6 M (P = 0.62, P = 0.22, and P = 0.85, respectively; Table 2, Fig. 3).
Horizontal aniseikonia scores
Investigation of AH indicated that in the Good group, at the preoperative, post-1 M, post-3 M, post-6 M, and post-12 M time points, macropsia was observed at rates of 3.03%, 2.78%, 2.61%, 2.81%, and 3.17%, respectively, indicating no changes as compared with the preoperative rate (P = 0.68, P = 0.49, P = 0.71, and P = 0.82, respectively). In the Moderate group, at the preoperative, post-3 M, and post-6 M time points, macropsia was observed at rates of 3.6%, 5.11%, and 5.2% respectively, indicating significant worsening at post-3 M and post-6 M (P = 0.013 and P = 0.009, respectively). Though there were no significant differences between the groups at the preoperative time point (P = 0.51), in the Good group, significantly less macropsia was observed at post-3 M and post-6 M (P = 0.005 and P = 0.007, respectively; Table 2, Fig. 4).
Vertical aniseikonia scores
Investigation of AV indicated that in the Good group, at the preoperative, post-1 M, post-3 M, post-6 M, and post-12 M time points, macropsia rates were 2.78%, 2.56%, 2.56%, 2.96%, and 3.14%, respectively, indicating neither significant improvement nor worsening as compared with the preoperative rate (P = 0.69, P = 0.69, P = 0.75, and P = 0.52). In the Moderate group, macropsia was observed at rates of 4.09%, 5.2%, and 5.56% respectively, indicating significant worsening at post-6 M (P = 0.053 and P = 0.011). Macropsia was significantly milder in the Good group at the post-3 M and post-6 M time points as compared to the preoperative value (P = 0.004 and P = 0.004, respectively; Table 2, Fig. 5).
Binocular vision
Investigation of binocular vision indicated that in the Good group, binocular vision values at the preoperative, post-1 M, post-3 M, post-6 M, and post-12 M time points were 1.92, 1.97, 1.95, 1.98, and 1.93, respectively, indicating no change as compared with the preoperative value (P = 0.44, P = 0.60, P = 0.32, and P = 0.88, respectively). In the Moderate group, the preoperative, post-3 M, and post-6M values were 2.21, 2.11, and 2.04, respectively, indicating significant improvement at post-6 M (P = 0.014). Although intergroup comparison showed that stereopsis was significantly better in the Moderate group at the preoperative time point (P = 0.02), no significant intergroup differences were found at either post-3 M or post-6 M (P = 0.18 and P = 0.63, respectively; Table 2, Fig. 6).
CFT measurements
In the Good group, the preoperative, post-1 M, post-3 M, post-6 M, and post-12 M CFT measurements were 388.4, 376.2, 349.5, 338.8, and 329.1 µm, respectively, indicating significant thinning at post-3M, 6M and 12M (P = 0.001, P < 0.0001, and P < 0.0001). In the Moderate group, the values were 485.7, 402.7, and 381.2 μm preoperatively, and at post-3 M and post-6 M, indicating significant thinning at all three time points (P < 0.0001 and P < 0.0001). Intergroup comparisons indicated that at the preoperative and post-3 M time points, CFT was significantly reduced in the Good group as compared to the controls (P < 0.0001 and 0.02), whereas no significant difference was found at the post-6 M time point (P = 0.065; Table 2, Fig. 7).
Factors affecting changes in horizontal metamorphopsia score (multivariate analysis)
Factors affecting changes in postoperative MH, including age, preoperative BCVA, preoperative MH, preoperative MV, preoperative AH, preoperative AV, and preoperative CFT, were investigated. Multivariate analysis identified only preoperative MH as a factor that affected changes in postoperative MH. (P < 0.0001, Table 3).
Horizontal metamorphopsia score variation
Variations in MH, as shown by the category model created, are presented in Figure 8. The post-6 M score was predicted to be 0.4997° based on the preoperative MH of 0.9°.
VFQ-25 (Good group only, Table 4)
General health: Post-6 M was 50.3 and post-12 M was 53.7, compared with 45.9 at the preoperative time point, indicating significant improvement at post-12 M (P = 0.004).
General vision: Post-6 M was 67.2 and post-12M was 69.3, compared with 59.5 at the preoperative time point, indicating significant improvements at both post-6 M and post-12 M (P = 0.005 and P = 0.0005).
Ocular pain: Post-6 M was 83.7 and post-12 M was 81.7, compared with 74.3 at the preoperative time point, indicating significant improvements at both post-6 M and post-12 M (P = 0.002 and P = 0.014).
Near activities: Post-6 M was 68.2 and post-12 M was 67.8, compared with 64.2 at the preoperative time point, indicating significant improvement at post-12 M (P < 0.0001).
Distance activities: Post-6 M was 77.5 and post-12 M was 79.2, compared with 75.7 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.45 and P = 0.138).
Social functioning: Post-6 M was 85.4 and post-12 M was 91.6, compared with 87.8 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.373 and P = 0.178).
Mental health: Post-6 M was 76.2 and post-12 M was 79.5, compared with 70.4 at the preoperative time point, indicating significant improvement at the post-6 M and the post-12 M time point (P = 0.047 and P = 0.002).
Role difficulties: Post-6 M was 79.6 and post-12 M was 82.9, compared with 80.4 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.81 and P = 0.45).
Dependency: Post-6 M was 91.5 and post-12 M was 93.0, compared with 89.0 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.23 and P = 0.058).
Driving: Post-6M was 74.2 and post-12 M was 73.4, compared with 74.3 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.996 and P = 0.906).
Color vision: Post-6 M was 94.4 and post-12 M was 95.7, compared with 93.2 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.649 and P = 0.332).
Peripheral vision: Post-6 M was 71.9 and post-12 M was 77.8, compared with 70.3 at the preoperative time point, indicating no significant improvement at either postoperative time point (P = 0.684 and P = 0.068).
No complications, such as postoperative endophthalmitis, retinal detachment, and vitreous hemorrhage, were observed.