Abstract / Summary
Purpose: To evaluate the association of photoreceptor outer segment (OS) destruction at the borders of idiopathic macular hole (IMH) with retinal and choroidal vascular density, as well as the impact of photoreceptor damage on preoperative and postoperative retinal function. Methods: Forty-two eyes of 42 patients diagnosed with IMH underwent a full ophthalmologic examination preoperatively and at 1, 3, and 6 months postoperatively, including swept-source optical coherence tomography (SS-OCT), OCTA, best-corrected visual acuity (BCVA), microperimetry and multifocal electroretinography (mfERG). Results: After adjusting for confounders, multivariate regression analysis revealed that bumpy borders were negatively correlated with the foveal choriocapillaris density (P = 0.006). Preoperatively, eyes with bumpy borders demonstrated significantly poorer BCVA (P < 0.001), lower mean foveal sensitivity (P = 0.007), and reduced P1 wave amplitude density in ring 1 on mfERG (P = 0.019) compared with eyes with smooth borders. Postoperatively, significant differences in BCVA (P = 0.006) and foveal sensitivity (P = 0.01) persisted at 1 month, with the addition of significantly lower foveal sensitivity (P = 0.032) and P1 amplitude in ring 1 (P = 0.019) at 3 months. By the final 6-month follow-up, only BCVA remained significantly worse in the bumpy border group (P = 0.023). Conclusions: Bumpy IMH border morphology is associated with reduced preoperative foveal choriocapillaris density and independently predicts poorer postoperative visual recovery, thereby providing a crucial foundation for elucidating the mechanisms underlying photoreceptor damage in IMH.