Predicting macular hole surgery outcomes: Integrating preoperative OCT features with supervised machine learning statistical models

Purpose: To evaluate various supervised machine learning (ML) statistical models to predict anatomical outcomes after macular hole (MH) surgery using preoperative optical coherence tomography (OCT) features.

Methods: This retrospective study analyzed OCT data from idiopathic MH eyes at baseline and at 1-month post-surgery. The dataset was split 80:20 between training and testing. XLSTAT® statistical software (Lumivero, USA) was used to train different ML models on 10°CT parameters: prefoveal posterior cortical vitreous status, epiretinal membrane, intraretinal cysts, foveal retinal pigment epithelium hyperreflectivity, MH basal diameter, MH area (MHA), hole-forming factor, MH index, tractional hole index, and diameter hole index. The most effective statistical model was identified and was further assessed for accuracy, sensitivity, and specificity on a separate testing dataset.

Results: Six ML statistical models were trained on 33,260°CT data points from 3326°CT images of 308 operated MH (300 patients) eyes. Following training and internal validation, the random forest (RF) model achieved the highest accuracy (0.92), precision (0.94), recall (0.97), and F-score (0.96), and lowest misclassification rate. RF model identified the MHA index as the best predictor of post-surgical anatomical success. Following external testing, the RF model confirmed the highest accuracy and lowest misclassification rate (8.8%).

Conclusion: ML-based statistical models can be used to predict MH status after surgery. The RF model was the most accurate ML model, and the MHA index was the best predictor of postoperative hole closure after surgery based on preoperative OCT parameters. These predictions may help with future surgical planning for MH patients.