Changes in Choroidal Structure Associated with Idiopathic Macular Hole Border Morphology

Objectives: To investigate the association between the hole border morphology and choroidal structure in idiopathic macular hole (IMH) patients and its impact on visual outcomes. Methods: A retrospective case-control study of 34 IMH eyes and 34 control eyes was conducted. Spectral-domain optical coherence tomography (SD-OCT) was used to categorize the patients into groups with smooth or bumpy hole borders. Based on this classification, a further evaluation was conducted of MH morphology and choroidal structure, both before a vitrectomy and at 1 and 2 months post-surgery. The choriocapillaris, Sattler's layer, and Haller's layer were the divisions of each choroidal vascular layer. Then, binarization techniques were employed to calculate the choroidal area (CA), luminal area (LA), stromal area (SA), and central choroidal thickness (CCT). The L/C ratio was established as the ratio of LA to CA. Results: In the patients with IMH, the choroidal structure was associated with the morphology of the hole border. In particular, the eyes with bumpy hole borders were significantly correlated with reduced choroidal thickness and total choroidal area, as well as a reduced L/C ratio in the choriocapillaris. After surgery, visual acuity improved in both groups, but the patients with smooth hole borders achieved earlier and higher levels of visual recovery. The multivariate analysis suggested that a bumpy hole border and the basal hole diameter were independent predictors of postoperative choriocapillaris recovery. Conclusions: Bumpy idiopathic macular hole borders are associated with impaired choroidal vasculatures, particularly in the choriocapillaris, which may be a contributing factor to delayed visual acuity recovery post-surgery.