Quantifying optimal inner limiting membrane peeling in macular hole surgery: a machine learning framework for predictive modeling and schematic visualization.

Purpose: Internal limiting membrane (ILM) peeling in macular hole (MH) surgery is critical but challenging, and current practices lack standardized tools for quantifying and visualizing optimal peeling dimensions.This study aimed to develop a machine learning framework to recommend surgeon-specific ILM peeling radius during macular hole surgery, integrating predictive modeling with schematic visualization to guide operative planning.

Methods: This retrospective study analyzed data from 95 patients with idiopathic MH who underwent vitrectomy with ILM peeling. Preoperative and postoperative optical coherence tomography (OCT) images were used to measure key MH parameters, including minimum diameter (MIN), base width (BASE), temporal length (T), nasal length (N), and height (H). The dataset was preprocessed by addressing missing values and applying Z-score normalization. 10 regression models were trained and evaluated using an 80 - 20 train-test split. Model performance was assessed using root mean squared error (RMSE), mean squared error (MSE), mean absolute error (MAE), and the coefficient of determination (R²). A graphical user interface (GUI) was developed to generate ILM peeling schematic diagrams from OCT data.

Results: The Ridge Regression model demonstrated the best performance, with an RMSE of 0.0320, MSE of 0.0010, MAE of 0.0209, and R² of 0.9427. The generated ILM peeling schematic diagrams provided clear visual representations, aiding surgical planning and education.

Conclusion: The Ridge Regression model effectively predicts the optimal ILM peeling radius. The integration of schematic diagram generation enhances surgical planning and provides valuable educational resources, highlighting the potential of machine learning and visualization tools in improving MH surgery outcomes.