Lukpan ORAZBEKOV, Kairat RUSLANULY, Elmira KANAFYANOVA, Altynai KAIRAT
Beyoglu Eye Journal - 2026;11(2):160-168
Objectives: This study evaluated the clinical utility of a multimodal large language model-based artificial intelligence (AI) model in predicting postoperative visual outcomes following full-thickness macular hole (FTMH) surgery using the inverted internal limiting membrane (ILM) flap technique. Methods: A retrospective analysis was conducted on 45 patients who underwent pars plana vitrectomy for FTMH at a tertiary eye care center between January 2021 and December 2023. Preoperative optical coherence tomography (OCT) images, demographic data, and clinical parameters were analyzed using the AI model to predict best-corrected visual acuity (BCVA) at four postoperative time points. The predicted BCVA values were then compared with actual clinical outcomes. Results: Preoperatively, the mean AI-predicted BCVA was 1.13+/-0.20 logMAR compared with the actual value of 1.24+/-0.33 logMAR (p=0.192). At 6 months, the predicted BCVA was 0.65+/-0.20 logMAR versus the actual value of 0.67+/-0.25 logMAR (p=0.528), and at 12 months, it was 0.47+/-0.17 logMAR versus 0.55+/-0.27 logMAR (p=0.155). However, at 7 days postoperatively, the model significantly overestimated visual impairment, predicting 1.37+/-0.28 logMAR versus the actual value of 1.07+/-0.33 logMAR (p<0.001). Spearman correlation analysis showed the strongest association between AI-predicted and actual BCVA at 6 months (r ?=0.5885, p<0.001), with a moderate correlation at 12 months (r ?=0.4156, p=0.005), a weak correlation preoperatively (r ?=0.3029, p=0.043), and no significant correlation at 7 days (r ?=0.1949, p=0.199). Conclusion: These findings demonstrate the model's potential as a supportive tool for visual outcome prediction after FTMH surgery. The AI platform showed clinically relevant predictive performance for preoperative and later postoperative visual outcomes after FTMH surgery, particularly at 6 and 12 months, but was less reliable in the early postoperative period.
