Multimodal Imaging Analysis of Supra-retinal Pigment Epithelium Granular Deposits in Treatment-Naive Full-Thickness Macular Holes.

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2025-02-24 DOI:10.1016/j.oret.2025.02.016

Daniela Bacherini, Stefano Mercuri, Andrea Govetto, Laura Di Leo, Tomaso Caporossi, Francesco Faraldi, Stanislao Rizzo, Gianni Virgili, Fabrizio Giansanti

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Abstract

Purpose: To describe the morphology and provide anatomical correlations of supra-retinal pigment epithelium (RPE) granular deposits in full-thickness macular holes (FTMHs).

Design: Retrospective, observational, single-center study.

Participants: Patients with idiopathic FTMH presenting to the University of Florence Eye clinic.

Methods: Thirty-six eyes of 34 patients with a diagnosis of treatment-naive FTMH, scheduled for surgery, underwent multimodal imaging including spectral-domain OCT (SD-OCT), en-face OCT, and adaptive optics ophthalmoscopy (AOO). Different methodologies were evaluated to determine the location and topographical correspondence of granulations. The total volume of supra-RPE granular deposits was correlated to the macular hole (MH) characteristics and SD-OCT markers of photoreceptor damage with Spearman correlation coefficient (CC).

Main outcome measures: Morphological correlations in FTMHs using SD-OCT and AOO.

Results: Using AOO, supra-RPE granular deposits appeared as hyper-reflective structures, mostly found within the minimum linear diameter (MLD) (104 of 139 deposits, 74%). Different imaging techniques were equally effective in the topographical identification of supra-RPE granular deposits (P > 0.30). The total volume of supra-RPE granular deposits significantly increased with stages B and C of FTMH, inversely correlated to the corrected ellipsoid zone (EZ) reflectivity (CC = -0.62) and positively correlated to the length of the EZ defect (CC = +0.41) and MH diameter at the base (CC = +0.35) and MLD (CC = +0.42) (all P < 0.05).

Conclusions: Supra-RPE granular deposits can be identified accurately using AOO and en-face OCT. Characteristics using AOO and anatomical correlations at SD-OCT indicate supra-RPE granular deposits as signs of photoreceptor degeneration.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

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