Volume of Opercular and Pseudopercular Tissue Is Associated With Outer Retinal Reconstitution After Full-Thickness Macular Hole Surgery

PURPOSE: To quantitatively evaluate the operculum-pseudoperculum volume (OPV) in full-thickness macular holes (MHs) and explore its relationship with anatomical and functional outcomes following surgery. METHODS: This prospective study included patients with Stage 2 and Stage 3 MHs who underwent pars plana vitrectomy. OPV was measured using image processing software and its correlation with postoperative changes in visual acuity (VA), external limiting membrane (ELM), and ellipsoid zone (EZ) defect in each group, then a median split was applied to investigate the impact of OPV on baseline and final measures. Multivariable regression analysis was conducted to determine predictors of VA improvement. RESULTS: In stage 2 MHs, OPV positively correlated with VA, minimum diameter (MD), basal diameter (BD), MH height (MHe) and changes in ELM at 3 and 6 months (p < 0.05). Only EZ changes at 6 months negatively correlated with OPV (p < 0.05). Patients with low OPV demonstrated greater EZ and ELM defect reduction at 6 months, whereas greater ΔVA was observed in the high-OPV group (p = 0.032). Multivariate analysis revealed that MD and OPV group were independent predictors of ΔVA at six months (Adjusted R2 = 0.266). CONCLUSIONS: OPV may represent a promising exploratory OCT-derived biomarker associated with postoperative structural and functional recovery in FTMH surgery. Larger longitudinal studies with external validation are warranted to confirm its prognostic utility.