AIM:To investigate the role of fundus autofluorescence (FAF) both in the diagnosis and the preoperative and postoperative evaluation of patients with idiopathic macular hole (MH).METHODS: Forty eyes of 40 patients diagnosed as idiopathic MH between May 2010 and May 2011 were included in this retrospective study. All patients underwent full ophthalmologic examinations and imagings including fluorescein angiography, fundus autofluorescence (FAF) and optical coherence tomography. Thirty of these patients underwent MH surgery. FAF findings were associated with duration of symptoms, visual acuity at presentation, stage of MH, and postoperative anatomical correction.RESULTS:The mean duration of patients’ symptoms was 3.8±2.0 (1-9) months. The MH was stage 2 in 4 (10%), stage 3 in 24 (60%) and stage 4 in 12 (30%) eyes. The median preoperative best corrected visual acuity was 20/200 (between 20/800 and 20/100). Twenty-eight of cases (70%) showed a stellate appearance with dark radiating striae. Having a visual acuity ≥20/200 was significantly more common in eyes with stellate appearance (P<0.001). The mean duration of symptoms was significantly shorter in eyes with stellate appearance (2.75±0.8 vs 6.33±1.61 months) (P<0.001). The frequency of stage 4 MH was significantly higher in eyes with non-stellate appearance (P<0.001). Anatomical correction of MH was achieved in 91.3% (21/23) of eyes with stellate appearance and 71.4% (5/7) of eyes without this appearance (P=0.225).CONCLUSION: Stellate appearance in FAF is associated with earlier stages of macular hole, better visual acuity at presentation, shorter duration of symptoms, thus more favorable prognosis.