{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:10:17Z","timestamp":1790035817870,"version":"4.0.1"},"reference-count":24,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: A macular hole represents a significant surgical condition in an increasingly aging population. Advances in surgical techniques, particularly pars plana vitrectomy with inverted internal limiting membrane (ILM) flap, have established high anatomical closure rates exceeding 90%. The prognostic factors influencing visual recovery remain incompletely understood, and it is unclear which patients can be expected to achieve optimal functional outcomes. Methods: This retrospective longitudinal study included 35 eyes of 32 patients followed for 3\u201312 months. Preoperative OCT parameters (minimum linear diameter, basal diameter, and hole height) and derived indices were correlated with functional outcomes, including best-corrected visual acuity (BCVA) and microperimetry, stratified as central macular sensitivity (CMS) and sensitivity at 4\u00b0 and 20\u00b0. Postoperative ellipsoid zone (EZ) and external limiting membrane (ELM) integrity were also analyzed. Predictive performance was assessed using root mean square error (RMSE) and coefficient of determination (R2). A linear regression model based on BCVA served as baseline, while Extreme Gradient Boosting (XGBoost) models incorporating OCT features were developed. Feature importance was evaluated using Shapley Additive Explanations (SHAP). Results: Overall closure rate was 100%, including 91.4% Type 1 and 8.6% Type 2 closure. Models incorporating OCT parameters outperformed BCVA-based models (lower RMSE, and higher R2). Minimum linear diameter and hole height were the strongest predictors of postoperative outcomes. Microperimetry detected functional improvement beyond BCVA and correlated with EZ and ELM restoration. Conclusions: Preoperative macular hole morphology represents a key determinant of postoperative functional recovery. These structural parameters provide meaningful prognostic value beyond visual acuity alone, supporting the role of combined OCT and microperimetric assessment in predicting surgical outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics16121919","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:49:55Z","timestamp":1782121795000},"page":"1919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preoperative OCT Biomarkers as Predictors of Postoperative Functional Outcome Assessed by Microperimetry After Inverted ILM Flap Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7357-0512","authenticated-orcid":false,"given":"Ovidiu","family":"Samoil\u0103","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7020-8493","authenticated-orcid":false,"given":"Anca M\u0103d\u0103lina","family":"Sere","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u0103cr\u0103mioara","family":"Samoil\u0103","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-8622","authenticated-orcid":false,"given":"Daniel-Corneliu","family":"Leucu\u021ba","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.ophtha.2010.02.011","article-title":"Inverted internal limiting membrane flap technique for large macular holes","volume":"117","author":"Michalewska","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3334","DOI":"10.1038\/s41433-024-03301-z","article-title":"Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: Conventional internal limiting membrane peeling versus inverted flap","volume":"38","author":"Fallico","year":"2024","journal-title":"Eye"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1159\/000534873","article-title":"Inverted internal limiting membrane flap versus internal limiting membrane peeling for <400 \u03bcm macular hole: A meta-analysis and systematic review","volume":"66","author":"Li","year":"2023","journal-title":"Ophthalmic Res."},{"key":"ref_4","first-page":"6624904","article-title":"Inverted ILM flap technique in idiopathic full-thickness macular hole surgery: Functional outcomes and their correlation with morphologic findings","volume":"2021","author":"Carpineto","year":"2021","journal-title":"J. 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