RISK-FACTORS FOR IDIOPATHIC MACULAR HOLES

PURPOSE: A case-control study was conducted to identify possible risk factors for idiopathic macular holes. METHODS: One hundred ninety-eigh t patients with idiopathic macular holes and 1,023 control subjects we re identified at five clinical centers, Data were obtained through int erviews, clinical examinations, and laboratory analyses of blood speci mens. RESULTS: One hundred forty-three (72%) affected patients were wo men. Very few of a broad array of possible risk factors were statistic ally significant. In a logistic regression model that included both ge nders, higher plasma fibrinogen levels (P = .0007) and a history of gl aucoma (P = .04) were associated with an increased risk of idiopathic macular holes. When the same model was used for women, with estrogen u se and parity added as variables, a higher fibrinogen level (P = .002) was positively associated, and estrogen use (P = .04) was negatively associated with risk of macular holes. CONCLUSIONS: Of the two factors that stood out as possible risk factors for idiopathic macular holes, the increased risk for women has long been recognized. The associatio n with fibrinogen level was unexpected, and it is unclear whether this is a chance finding or whether higher levels of fibrinogen can increa se susceptibility to the forces of vitreous traction, perhaps by compr omising the macular blood supply or by some yet unexplained mechanism.