Predictors of foveal microstructural reconstruction after idiopathic macular hole surgery

To identify prediction models and risk factors for anatomical microstructural reconstruction after surgery for idiopathic macular holes (IMHs).

This retrospective study involved 74 patients (77 eyes) who underwent successful closure after IMH surgery. The conventional MH indicators, macular hole occupancy index (MHOI) and internal limiting membrane (ILM) peeling index were calculated. Binary logistic regression analysis was used to identify prognostic factors and establish predictive models.

The early postoperative anatomy of the inner segment/outer segment (IS/OS) showed a significant correlation with the MHOI, macular hole index (MHI), and traction hole index (THI) (P = 0.018, P = 0.047, P = 0.002, at-1-month; P = 0.008, P = 0.014, P = 0.005, at-3-months). Poorer preoperative best-corrected visual acuity (BCVA) (β = 2.954, P = 0.002) and larger inferior ILM peeling index (IIPI) (β = 7.446, P = 0.006) predicted poorer IS/OS prognosis. The early postoperative continuity of external limiting membrane (ELM) was significantly associated with the MHOI(P = 0.005), diameter hole index (DHI) (P = 0.031), MHI (P = 0.004), and THI (P < 0.001). Larger IIPI (β = 8.490, P = 0.004 at-1-month) and poorer preoperative BCVA (β = 3.665, P = 0.001, at-1-month; β = 4.342, P = 0.002, at-3-months) were independent risk factors. Outer nuclear layer (ONL) disruption was significantly predicated by poorer preoperative BCVA (β = -2.781, P = 0.019) and larger IIPI (β = -5.653, P = 0.061). IS/OS and ELM integrity correlated with early postoperative BCVA, whereas the ONL showed sustained significance over 6 months.

MHOI, MHI, and THI influenced the repair of the IS/OS, ELM, and ONL in the short-term. Preoperative BCVA and IIPI were crucial for long-term prognosis of foveal microstructure. Foveal microstructure integrity is closely related to postoperative visual function recovery.