Multimodal Imaging Analysis of Supra-Retinal Pigment Epithelium Granular Deposits in Treatment-Naive Full-Thickness Macular Holes

Purpose: To describe the morphology and provide anatomical correlations of supra-retinal pigment epithelium (RPE) granular deposits in full thickness macular holes (FTMHs). Design: Retrospective, observational, single-center study PARTICIPANTS: Patients with idiopathic FTMH presenting to University of Florence Eye clinic METHODS: Thirty-six eyes of 34 patients with diagnosis of treatment-naive FTMH, scheduled for surgery, underwent multimodal imaging including spectral-domain optical coherence tomography (SD-OCT), en-face OCT and adaptive optics ophthalmoscopy (AOO). Different methodologies were evaluated to determine location and topographical correspondence of granulations. Total volume of supra-RPE granular deposits was correlated to MH characteristics and SD-OCT markers of photoreceptor damage with Spearman correlation coefficient (CC). Results: Using AOO, supra-RPE granular deposits appeared as hyper-reflective structures, mostly found within the minimum linear diameter (MLD) (104/139 deposits,74%). Different imaging techniques were equally effective in the topographical identification of supra-RPE granular deposits (p>0.30). The total volume of supra-RPE granular deposits significantly increased with stages B and C of FTMH, inversely correlated to the corrected ellipsoid zone (EZ) reflectivity (CC=-0.62) and positively correlated to the length of EZ defect (CC=+0.41), MH diameter at the base (CC=+0.35) and MLD (CC=+0.42)(all p<0.05). Conclusions: Supra-RPE granular deposits can be identified accurately using AOO and en-face OCT. Characteristics using AOO and anatomical correlations at SD-OCT indicate supra-RPE granular deposits as signs of photoreceptor degeneration.