OphthoEvidence report: Baseline structural optical coherence tomography biomarkers as predictors of visual outcomes following full-thickness macular hole surgery: A systematic review and meta-analysis protocol

BACKGROUND: Full-thickness macular hole (FTMH) is a vitreoretinal condition affecting the foveal center that causes central vision loss and metamorphopsia. Despite high surgical success in achieving closure, functional visual recovery remains unpredictable. Identifying reliable optical coherence tomography (OCT) biomarkers that predict postoperative outcomes could improve patient counselling and surgical decision-making. OBJECTIVE: To systematically evaluate the predictive value of baseline structural OCT biomarkers for visual acuity (VA) outcomes at 3, 6, 12, and 24 months following FTMH surgery. METHODS: We will search PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception for studies evaluating baseline OCT parameters as predictors of postoperative VA outcomes following FTMH surgery, with minimum follow-up of 3 months. Data will be synthesized using random-effects meta-analyses. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. CONCLUSIONS: This systematic review will synthesize current evidence on OCT biomarkers' predictive value for FTMH surgical outcomes. The findings will clarify their clinical utility and may inform individualized prognostic counselling and surgical decision-making, including which patients are most likely to benefit from surgery and which surgical techniques may be most effective given specific OCT profiles.