Dear Dr. Masuki,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Kumar Saurabh

Academic Editor

PLOS One

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When submitting your revision, we need you to address these additional requirements.

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2. Please amend your authorship list in your manuscript file to include author Heavenlight Estomihi Masuki, Jovin S Sagale, Celina F Mhina.

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Additional Editor Comments:

Authors are invited to go through the reviewers comments and reply them suitably.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: I thank authors for their submission. Few queries from my side

1) Specific percentage be mentioned who achieved hole closure post-operatively

2) Authors have included 7 traumatic macular holes in their study group while majority being idiopathic. As visual prognosis and outcome gets related to multiple factors, its better to keep traumatic holes away from the study group to have homogeneous inclusion and more significant data.

3) Authors have mentioned, silicone oil as a vitreous tamponade was associated with a higher success rate for macular hole closure compared to gas tamponade. Studies worldwide have mentioned silicone oil to be suitable for recurrent or complex macular holes, particularly those associated with retinal detachment and they usually end up having reduced anatomical success rates. Do authors have some more logical explanations in support of their finding?

References :

a) Cillino S, Cillino G, Ferraro LL et al. Treatment of persistently open macular holes with heavy silicone oil (Densiron 68) versus C2F6. A prospective randomized study. Retina. 2016;36(4):688–94. 74.

b) Nowroozzadeh MH, Ashraf H, Zadmehr M, et al. Outcomes of light silicone oil tamponade for failed idiopathic macular hole surgery. J Ophthalmic Vis Res. 2018;13(2):130–7. 75

c) Lai JC, Stinnett SS, McCuen BW. Comparison of silicone oil versus gas tamponade in the treatment of idiopathic full-thickness macular hole. Ophthalmology. 2003;110(6):1170–4

Reviewer #2: 1.The correlation of size of macular hole and anatomical closure and visual improvement will enhance value of the study.

2. The incidence of glaucoma in the study . the effect of vision recovery in the eyes having glaucoma in the study.

**********

what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

**********

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To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr. Masuki,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 14 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Alan Marmorstein

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Additional Editor Comments:

This is an interesting and informative retrospective analysis of macular hole outcomes in Tanzania. I have been asked to take over the review of the manuscript from the prior editor. Unfortunately I do not believe the authors have adequately responded to the prior review. In particular Reviewer 1 point 3. In addition, they were not able to provide the data on hole size or glaucoma requested by reviewer 2, though this is understandable in a retrospective study. I have several comments/questions that I think will significantly improve the manuscript:

1. I share reviewer 1’s concern regarding the repeated claim that the success rate for silicon oil is higher than gas tamponade. Since only 2 of 101 eyes received a silicon oil tamponade the higher success rate observed must be tempered with the fact that the silicon oil group is not sufficiently powered to compare to the gas tamponade group. For this reason I would strongly suggest that the authors change their statements to reflect the small sample size, and refrain from making forward statements about the higher success rate of silicon oil. If those eyes were first treated with a gas tamponade unsuccessfully, and then silicon oil, that would be a point worthy of discussion.

2. I very strongly advise the authors to have a biostatistician review the statistical analysis of all the data. Again, I am concerned by the emphasis on the 2 eyes treated with silicon oil, which does not seem sufficiently powered to compare with gas tamponade causing me to question the other statistical data. In general, I always have a biostatistician check my own work, and I think it is a good practice. The biostatistician should be acknowledged in the manuscript.

3. One wonders whether the lower success rate of macular hole repair in this study is due to patient compliance with positioning instructions? Do the authors have any thoughts on this?

4. What is the racial/ethnic makeup of the cohort and was it uniform? If not, were there differences among groups?

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

**********

Reviewer #2: (No Response)

**********

what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

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

PONE-D-25-51893R2

Dear Dr. Masuki,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Alan Marmorstein

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: