Abstract
PURPOSE: Delayed macular hole (MH) closure poses a clinical challenge, yet few studies have examined the influence of systemic metabolic factors such as dyslipidemia on postoperative retinal repair. This study investigated risk factors associated with delayed closure after MH surgery, with a particular focus on dyslipidemia. METHODS: We retrospectively analyzed 432 patients who underwent MH surgery with an internal limiting membrane (ILM) flap technique at Tianjin Eye Hospital between 2015 and 2024. Clinical and biochemical parameters-including total cholesterol (TC), triglycerides (TG), age, sex, and postoperative positioning compliance-were assessed. Multivariable logistic regression, smoothed curve fitting, and threshold-effect analyses were used to identify predictors of delayed MH closure. RESULTS: Of the 432 patients, 60 experienced delayed MH closure. Higher TC and TG levels were significantly associated with delayed closure after adjustment for confounders. These findings suggest that lipid dysregulation may contribute to slower retinal repair. CONCLUSION: Dyslipidemia is associated with delayed MH closure, highlighting a potential role of systemic metabolic dysfunction in postoperative retinal recovery. Lipid-lowering strategies may be considered as adjunctive measures to improve surgical outcomes. Prospective studies are warranted to validate these findings and explore targeted interventions.