Clinical course of macular holes - The eye disease case-control study

Objective: To describe the clinical course of affected and unaffected eyes in patients with idiopathic macular holes. Patients: Prospective study of patients with macular holes enrolled in the Eye Disease Case-Control Study. Main Outcome Measures: The best-corrected visual acuity at follow-up was co mpared with that at baseline. Changes in the macular holes, including incre ases in size or spontaneous regression, were assessed. The rates of develop ment of new macular holes in fellow unaffected eyes were estimated. Results: Of the 198 patients examined at baseline, 28 (14.1%) died before r eevaluation. Of those who survived, 122 (71.8%) had a follow-up examination . Approximately 34% (34.4%) of all eyes with macular holes had an increase in the size of the macular hole. Forty-five percent of eyes had a decrease in visual acuity of 2 or more lines and 27.8%, of 3 or more lines; 40.9% re mained stable, with a gain or loss of fewer than 2 lines. The rate of devel opment of a new macular hole during follow-up in fellow eyes that were unaf fected at baseline was 4.3% for 3 or fewer years of follow-up, 6.5% for 4 t o 5 years of follow-up, and 7.1% for 6 or more years of follow-up. Spontane ous regression of the macular hole occurred in 3 (8.6%) of 35 patients with a follow-up interval of 6 or more years, whereas no regression occurred in patients with a shorter follow-up. Conclusions: The visual acuity of 45.0% of eyes with macular holes deterior ated by 2 or more lines during follow-up. The rate of development of macula r holes in unaffected fellow eyes was low.