PURPOSE: To investigate whether the morphology of supra-retinal pigment epithelial (RPE) deposits influences anatomical and functional outcomes in idiopathic full-thickness macular holes (FTMHs). METHODS: In this retrospective study 66 eyes from 66 patients with idiopathic FTMH undergoing vitrectomy with ILM peeling were analyzed. Supra-RPE deposits were segmented from en face 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 six months after surgery. Best-corrected visual acuity (VA) was recorded in logMAR units. RESULTS: 38 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 EZd (p=0.035) and 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% CI 0.02-0.29, p=0.03). CONCLUSION: 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, though further work is required to confirm its independent prognostic value.
Quarta et al. (Mon,) studied this question.
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