Hypertransmission as a biomarker for predicting postoperative microstructure and function of idiopathic macular hole

To observe choroidal hypertransmission in idiopathic macular hole (IMH) before and after surgery using spectral-domain optical coherence tomography (SD-OCT), and to assess its correlation with retinal microstructure and visual outcomes to determine whether hypertransmission can serve as a biomarker for predicting IMH prognosis.

This retrospective, observational study included patients diagnosed with IMH at Shanxi Eye Hospital between January 2019 and December 2020, who successfully achieved hole closure after vitrectomy, and had complete follow-up data. SD-OCT was used to assess baseline and postoperative retinal structures, and best-corrected visual acuity (BCVA) was recorded. The follow-up time was 3-52 months.

Fifty-four eyes (53 patients) were enrolled. On preoperative SD-OCT, 41 eyes (75.9 %) showed hypertransmission, with no differences in duration, MH stage, base diameter, pre- and postoperative BCVA, or restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) between patients with and without preoperative hypertransmission (p > 0.05). With or without hypertransmission on postoperative SD-OCT were 17 and 37 eyes showed significant differences in duration (p = 0.001), base diameter (p = 0.001), and baseline BCVA (p = 0.029), as well as in the intraoperative inner limiting membrane procedure (p = 0.012) and tamponade (p = 0.021). Multivariate regression analysis showed that only base diameter was associated with postoperative hypertransmission (p = 0.024, odds ratio [OR] = 1.004, 95 %CI 1.001-1.008). The ELM (17/20) and EZ (17/51) lines in 17 eyes with postoperative hypertransmission were not restored at the final follow-up.

Larger base diameter, poorer retinal microstructure, and visual acuity were associated with postoperative hypertransmission, indicating its potential as a biomarker for poor prognosis in patients with IMH.