Dynamic Structural Recovery Parameters Enhance Prediction of Visual Outcomes After Macular Hole Surgery

Purpose: To introduce novel dynamic structural parameters and evaluate their integration within a multimodal deep learning (DL) framework for predicting postoperative visual recovery in idiopathic full-thickness macular hole (iFTMH) patients. Methods: We utilized a publicly available longitudinal OCT dataset at five stages (preoperative, 2 weeks, 3 months, 6 months, and 12 months). A stage specific segmentation model delineated related structures, and an automated pipeline extracted quantitative, composite, qualitative, and dynamic features. Binary logistic regression models, constructed with and without dynamic parameters, assessed their incremental predictive value for best-corrected visual acuity (BCVA). A multimodal DL model combining clinical variables, OCT-derived features, and raw OCT images was developed and benchmarked against regression models. Results: The segmentation model achieved high accuracy across all timepoints (mean Dice > 0.89). Univariate and multivariate analyses identified base diameter, ellipsoid zone integrity, and macular hole area as significant BCVA predictors (P < 0.05). Incorporating dynamic recovery rates consistently improved logistic regression AUC, especially at the 3-month follow-up. The multimodal DL model outperformed logistic regression, yielding higher AUCs and overall accuracy at each stage. The difference is as high as 0.12, demonstrating the complementary value of raw image volume and dynamic parameters. Conclusions: Integrating dynamic parameters into the multimodal DL model significantly enhances the accuracy of predictions. This fully automated process therefore represents a promising clinical decision support tool for personalized postoperative management in macular hole surgery.