Long-term follow up of unoperated macular holes

Objective: To investigate the anatomic and visual acuity outcomes among pat ients with unoperated macular holes and at least 5 years of follow-up. Design: Retrospective, noncomparative case series from an institutional pra ctice setting. Participants: All patients with unoperated full-thickness macular holes eva luated at Bascom Palmer Eye Institute between January 1, 1968 and December 31, 1993 and observed for at least 5 years. Methods: Demographic and clinical data were abstracted from patients' medic al records and ophthalmologic photography records. For patients with bilate ral macular holes, only one eye was included. Main Outcome Measures: Visual acuity and clinical features on initial exami nation, at 5 years, and at final follow-up. Results: The study included 65 eyes of 65 patients with a median age of 65 years (range, 52-85 years) and a median follow-up of 9.3 years (range, 5-29 years). On initial examination at Bascom Palmer Eye Institute, the macular hole was stage 2 in 15 eyes (24%), stage 3 in 23 eyes (37%), and stage 4 i n 25 eyes (40%). At final follow-up, the macular hole was stage 3 in 10 eye s (16%) and stage 4 in 53 eyes (84%). Visual acuity was 20/200 or worse in 35 eyes (54%) on initial examination, in 43 eyes (74%) at 5 years, and in 5 3 eyes (82%) at final follow-up. Poorer visual acuity on initial examinatio n was a significant predictor of poorer final vision (P < 0.01). Other acco mpanying clinical features such as the presence of operculum, posterior vit reous detachment, and epiretinal membrane were not significantly associated with final vision. Throughout follow-up, there was a redistribution and re duced number of yellow nodular opacities at the level of the retinal pigmen t epithelium at the base of the macular holes and the development of retina l pigment epithelial atrophy around the macular holes. Conclusions: Long-term follow-up of unoperated macular holes demonstrates p rogression in hole size and stage, vision loss which generally stabilizes a t the 20/200 to 20/400 level, a redistribution and reduced number of yellow nodular opacities at the level of the retinal pigment epithelium, and the development of retinal pigment epithelial atrophy surrounding the macular h ole, resulting in a "bull's-eye" macular appearance. Ophthalmology 2001;108 :1150-1155 (C) 2001 by the American Academy of Ophthalmology.