Incidence and Risk Factors of Full-Thickness Macular Hole in Fellow Eyes

Summary

Fellow eye develops macular hole in 12% at 5 years. Main risks are VMT and no PVD — Retrospective, 576 patients.

Abstract

Purpose: To estimate the incidence of full-thickness macular hole (FTMH) bilateralization, identify risk factors for development in the fellow eye, and compare surgical outcomes between first and second eyes.

Design: Retrospective consecutive case series.

Participants: Patients with unilateral idiopathic FTMH.

Methods: Clinical records and spectral-domain OCT were reviewed to assess FTMH characteristics, bilateralization, and vitreoretinal interface status in the fellow eye, including posterior vitreous detachment (PVD), vitreomacular traction (VMT), epiretinal membrane, and lamellar hole.

Main outcome measures: Incidence of fellow-eye FTMH, time to bilateralization, risk factors, and surgical outcomes.

Results: Among 576 patients (mean age, 67.2 ± 8.7 years), 34 (5.9%) experienced a fellow-eye FTMH over a mean follow-up of 27.3 ± 25.3 months. The cumulative incidence was 4% ± 1% at 1 year and 12% ± 2% at 5 years. Eyes with VMT had a markedly higher risk, reaching 19% ± 6% at 1 year and 27% ± 7% at 2 years, and developed FTMH earlier than eyes without VMT. In multivariable analysis, VMT was the strongest independent predictor of bilateralization (odds ratio, 12.9; 95% confidence interval, 3.5-47.2; P < 0.001). Axial length and high myopia were not associated with fellow-eye FTMH. Fellow-eye holes were smaller and had better visual acuity at diagnosis, but final visual acuity and closure rates were comparable to those of the first eyes.

Conclusions: Fellow-eye FTMH occurs in ∼12% of patients at 5 years. Vitreomacular traction and the absence of PVD are the principal risk factors, whereas high myopia does not increase the risk of bilateralization. Close surveillance is warranted, particularly within the first 2 years in eyes with VMT.