Background <p>Due to the small number of cases, limited knowledge exists on the surgical outcome of pediatric traumatic macular holes (MHs). This study aims to investigate the characteristics and surgical outcomes of pediatric traumatic MHs and analyse the associated factors of surgical outcomes.</p> Methods <p>59 pediatric patients that underwent vitrectomy for MHs caused by blunt trauma or laser pointer at a tertiary hospital were retrospectively recruited. Ophthalmic examination and optical coherence tomography were conducted at baseline and follow-ups.</p> Results <p>The etiologies of the MHs were blunt trauma in 43 eyes and laser pointer in 16 eyes. The overall closure rate was 89.8%. MHs that did not close were larger than MHs that closed (<i>P</i> = 0.001). Among eyes with closed MHs, 41.5% achieved best corrected visual acuity (BCVA) of 20/40 or better (good responder). The good responders had better preoperative BCVA (<i>P</i> = 0.029), smaller minimal diameter (<i>P</i> &lt; 0.001), and smaller preoperative ellipsoid zone defect (<i>P</i> = 0.002) than the poor responders (BCVA &lt; 20/40). Patients hurt by blunt trauma were more likely to be poor responders than patients injured by laser pointer (<i>P</i> = 0.025, OR = 0.240, 95%CI: 0.066 ~ 0.866).</p> Conclusions <p>Pediatric MHs could be caused by blunt trauma or laser pointer. Vitrectomy was effective in closing the holes and improving visual acuity. The anatomic outcome was related with MH size. Worse preoperative BCVA, larger MH size and blunt trauma injury were predictors of poor functional outcome.</p>