Idiopathic Macular Hole Area to Foveal Avascular Zone Ratio and Its Effects on Visual Acuity Before and After Surgery.

Purpose: This study investigates factors influencing visual acuity logarithmic minimum angle of resolution (logMAR) in idiopathic macular holes (IMH), with a focus on the foveal avascular zone (FAZ).

Methods: En face images from optical coherence tomography and optical coherence tomography angiography of 152 patients with stages 2, 3, and 4 IMH were analyzed. The minimum area (MA), base area, and FAZ of the macular hole were quantified, and the ratio of minimum area to FAZ (MFR) was calculated. In addition, central subfield thickness was extracted. Relationships between preoperative and postoperative visual acuity and these parameters, along with age, sex, axial length, and stage, were assessed using univariate and multivariate analyses.

Results: The study included 113 patients with high-quality images (113 eyes; median age, 69 years; interquartile range, 65-73 years). Multivariate analysis of factors significantly associated with pre- and postoperative visual acuity identified MFR as the only consistent independent factor (preoperative: β = 0.280, P < 0.05; postoperative: β = 0.357, P < 0.01).

Conclusions: The ratio of macular hole area to the FAZ may be a potentially important morphofunctional parameter influencing visual acuity outcomes in patients with IMH. These findings suggest that MFR could be useful in assessing surgical prognosis, although further research with larger, diverse cohorts is needed.

Translational relevance: This study bridges the gap between basic retinal morphology and clinical outcomes by identifying MFR as a predictor of visual acuity in patients with IMH. Incorporating MFR into preoperative evaluations could improve surgical prognostication.