· Objective: The purpose of the study was to study the relationship of postoperative visual outcome with anatomical parameters of macular holes using confocal scanning laser tomography and to predict the postoperative visual results. · Design: Cohort study. · Intervention and participants: We evaluated the eyes of 44 patients undergoing macular hole surgery (10 men and 34 women aged 40–76 years, mean 59.1 years). All patients showed idiopathic full-thickness stage 3 macular holes. The duration of symptoms was 1–4 months (mean 2.7 months). · Main outcome measures: The area, volume, mean depth, and maximum depth of the macular holes and the areas of cuff and retinal striae were measured using the Heidelberg Retina Tomograph preoperatively. · Results: All 44 eyes showed closure of the holes and flattening of cuff and retinal striae after vitrectomy and gas tamponade. Postoperative visual acuity was significantly correlated with the area (r=0.822, P<0.0001), volume (r=0.840, P<0.0001), mean depth (r=0.842, P<0.0001), and maximum depth (r=0.831, P<0.0001) of the macular holes, area of cuff (r=0.625, P<0.0001), and area of retinal striae (r=0.648, P<0.0001 ). Multiple regression analysis showed that the combination of the preoperative mean depth of macular holes and logarithm of preoperative visual acuity was the strongest predictor of the postoperative visual acuity. · Conclusions: Postoperative visual results vary significantly with the size of macular holes in patients with stage 3 macular holes of duration 1–4 months. The use of the confocal scanning laser tomography may facilitate the evaluation of macular holes before surgery. Ability to predict the postoperative visual results would be helpful in treating patients with macular holes.