Stage-Specific Morphofunctional Evaluation of Idiopathic Macular Holes Using En Face OCT Imaging

To evaluate stage-specific morphofunctional relationships in idiopathic macular holes (IMHs) and determine whether stage 2‑specific features could be explained by hole size alone.

Retrospective observational study.

A total of 105 eyes with IMHs and available 3-month postoperative follow-up data.

Eyes were stratified by Gass stage into stage 2 and stage 3 to 4 groups and by International Vitreomacular Traction Study size criteria into small and medium-to-large groups. Associations between preoperative optical coherence tomography (OCT) parameters and best-corrected visual acuity were assessed using interaction, stratified, and multivariable regression analyses.

Associations between preoperative morphological parameters and best-corrected visual acuity before surgery and at 1 and 3 months postoperatively.

Preoperative interactions with stage were significant for minimum linear diameter, minimum area/foveal avascular zone ratio, and minimum area. Stage 3 to 4 showed consistent morphofunctional associations, whereas stage 2 showed less consistent associations not fully explained by hole size. In multivariable analyses, predictors were more stable in stage 3 to 4 than in stage 2. Size-based classification showed less consistent patterns than stage-based stratification.

Stage 2 IMHs showed less consistent morphofunctional relationships than stage 3 to 4, and these differences were not fully explained by measured OCT-based size parameters alone. These findings support stage-aware interpretation of OCT-derived biomarkers and may inform future prognostic studies in IMHs.

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