MORPHOLOGIC DISTINCTION OF SUPRA-RPE DEPOSITS IN IDIOPATHIC FULL-THICKNESS MACULAR HOLES

To investigate whether the morphology of supra-retinal pigment epithelium (RPE) deposits influences anatomical and functional outcomes in idiopathic full-thickness macular holes (FTMHs).

In this retrospective study, 66 eyes from 66 patients with idiopathic FTMH undergoing vitrectomy with internal limiting membrane peeling were analyzed. Supra-RPE deposits were segmented from en face optical coherence tomography (OCT) slabs. Deposits were classified as fine deposits (FD) or granular deposits (GD) based on size. Baseline MH characteristics were measured on horizontal and vertical B-scans. Outcomes were assessed 6 months after surgery. Best-corrected visual acuity (VA) was recorded in logarithm of the minimum angle of resolution (logMAR) units.

Thirty eight eyes (58%) showed FD and 28 eyes (42%) GD. Baseline characteristics were comparable between groups. At 6 months after surgery, eyes with GD achieved worse postoperative VA ( P = 0.03) and showed greater disruption of outer retinal bands, with larger ellipsoid zone defect (EZd) ( P = 0.035) and external limiting membrane defect (ELMd) ( P = 0.048). ΔVA was significantly smaller in GD eyes (-0.40 vs. -0.65 logMAR, P < 0.001). In FD eyes, deposit area correlated with postoperative changes in EZd and ELMd, whereas no such association was found in GD eyes. In multivariable regression deposit morphology (GD vs. FD) independently predicted poorer visual improvement (β = 0.15, 95% confidence intervals [0.02-0.29], P = 0.03).

Supra-RPE deposits are frequently detectable by en face OCT in FTMH. GD identifies eyes with larger MHs and reduced likelihood of optimal postoperative functional recovery. These findings suggest that deposit phenotype may serve as an imaging biomarker of disease severity, although further work is required to confirm its independent prognostic value.