Full-Thickness Macular Hole: Are Supra-RPE Granular Deposits Remnants of Photoreceptors Outer Segments? Clinical Implications

• Published in: American journal of ophthalmology 2023-01, Vol.245, p.86-101
• Main Authors: Govetto, Andrea, Bacherini, Daniela, Romano, Mario R., Matteucci, Martina, Lucchini, Sara, Cifarelli, Lorenzo, Dragotto, Francesco, Cereda, Matteo, Parrulli, Salvatore, Staurenghi, Giovanni, Giansanti, Fabrizio, Virgili, Gianni, Bottoni, Ferdinando, Radice, Paolo
• Format: Article
• Language: English
• Subjects: Biomarkers; Diabetic retinopathy; Hospitals; Humans; Morphology; Photoreceptors; Retinal Perforations - diagnosis; Retinal Perforations - surgery; Retinal Pigment Epithelium; Retrospective Studies; Software; Statistical analysis; Surgeons; Surgery; Tomography, Optical Coherence - methods; Variables; Visual Acuity; Vitrectomy - methods
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2022.09.005

To describe the presence of specific morphological characteristics of idiopathic, full-thickness macular hole (MH) potentially influencing postoperative best corrected visual acuity (BCVA) and surgical outcomes. Retrospective, multicenter and interventional case series. Clinical charts and multimodal imaging pictures of 149 eyes of 143 consecutive patients diagnosed with MH, treated surgically and with a minimum follow-up of 12 months, were reviewed. Supra−retinal pigment epithelium (RPE) granular deposits were diagnosed in 121 of 149 eyes (81.2%). A smooth morphology was identified in 58 of 149 eyes (38.9%), whereas a bumpy border was present 91 of 149 eyes (61.1%). Photoreceptor disruption was mainly located close to the MH aperture. In 8% of the included cases, preoperative anatomical progression from smooth to bumpy morphology was noted. The presence of supra-RPE granular deposits was a significant predictor of lower postoperative BCVA only in univariate analysis (P < .001). The presence of a bumpy border was significantly correlated with lower postoperative BCVA in both univariate and multivariate analysis (P < .001). BCVA gain was significantly lower in MH with bumpy borders (P < .001). A bumpy border was also significantly associated with poor postoperative anatomical restoration (P < .001). Supra RPE-granular deposits and a bumpy morphology may be indicators of photoreceptor disruption in MH. A bumpy morphology may suggest deeper and potentially irreversible photoreceptor damage, and may negatively influence both functional and anatomical recovery. •Supra−retinal pigment epithelium (RPE) granular deposits may be remnants of photoreceptor outer segments.•A bumpy macular hole border may reflect deeper photoreceptor damage.•Optical coherence tomography imaging of supra-RPE granular deposits and macular hole borders compares well with histology.•A bumpy border may be an independent predictor of worse postoperative recovery.•Signs of photoreceptor disruption are mainly located close to the aperture.