Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI). [10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity. Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices. This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation. Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0. 704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation. Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0. 704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.Purpose: To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.Idiopathic macular hole (IMH) is a retinal disease commonly found in individuals aged over 50 years, which can lead to visual impairment due to a full-thickness hole in the foveolar area.[1] Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade has recently gained recognition as the primary surgical method for treating this condition, resulting in significant improvements in both anatomical closure and visual outcome.[2] Accordingly, reports have shown that the anatomical closure rate has increased to more than 90%. These findings have demonstrated the effectiveness of surgical interventions in treating IMH.[1,3,4] However, despite the high success rate of anatomical closure, some patients with IMH have poor postoperative best-corrected visual acuity (BCVA), even after a successful closure of the hole. The factors contributing to this phenomenon remain unclear and require further investigation.Optical coherence tomography (OCT) has been used to predict visual outcomes in patients with IMH using parameters such as minimum diameter (MD),[5] base diameter (BD),[6] hole height (HH),[7] macular hole index (MHI),[8] tractional hole index (THI),[9] diameter hole index (DHI),[9] hole form factor (HFF),[6] and macular hole closure index (MHCI).[10] However, these parameters have not proven satisfactory in predicting foveal microstructure and visual outcomes, emphasizing the need for further investigation to identify additional factors that may influence postoperative results.The use of spectral-domain optical coherence tomography (SD-OCT) has allowed for a comprehensive analysis of the outer retina layer. As a result, recent studies have emphasized the correlation between ellipsoid zone (EZ) reconstruction and external limiting membrane (ELM) bridging with postoperative visual acuity (VA) in patients with IMH.[11,12]However, until now, few retinal photoreceptor layer repair predictive indices are used clinically. Therefore, we proposed two practical and easily available new indices, hole healing index (HHI) and hole closure index (HCI), which are based on preoperative parameters such as HH, MD, HS, and BD of the macular hole (MH). The purpose of this study is to mainly assess the validity of the two new indices.This retrospective study was approved by the Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China), and the protocol was followed in full. All participants provided written informed consent before being included in the study. The research was conducted in accordance with the principles outlined in the Declaration of Helsinki.
