Stage-specific Morphofunctional Evaluation of Idiopathic Macular Holes Using En Face Optical Coherence Tomography Imaging

Purpose To evaluate stage-specific morpho-functional relationships in idiopathic macular holes (IMHs) and determine whether Stage 2-specific features could be explained by hole size alone. Design Retrospective observational study. Participants A total of 105 eyes with IMHs and available 3-month postoperative follow-up data. Methods Eyes were stratified by Gass stage into Stage 2 and Stage 3–4 groups and by IVTS size criteria into small and medium-to-large groups. Associations between preoperative OCT parameters and best-corrected visual acuity (BCVA) were assessed using interaction, stratified, and multivariable regression analyses. Main Outcome Measures Associations between preoperative morphological parameters and BCVA before surgery and at 1 and 3 months postoperatively. Results Preoperative interactions with stage were significant for minimum linear diameter, minimum area/foveal avascular zone ratio, and minimum area. Stage 3–4 showed consistent morpho-functional associations, whereas Stage 2 showed less consistent associations not fully explained by hole size. In multivariable analyses, predictors were more stable in Stage 3–4 than in Stage 2. Size-based classification showed less consistent patterns than stage-based stratification. Conclusions Stage 2 IMHs showed less consistent morpho-functional relationships than Stage 3–4, and these differences were not fully explained by measured OCT-based size parameters alone. These findings support stage-aware interpretation of OCT-derived biomarkers and may inform future prognostic studies in IMH.