Macular hole and myopic refraction

To study a correlation between age at the onset and myopic refraction and axial length in patients with idiopathic macular hole and to evaluate a correlation of the size and surgical outcome of macular hole with axial length.

In a prospective clinical study, 94 eyes of 91 patients with stage III and IV idiopathic macular hole were enrolled. A standardised surgical protocol was performed using vitrectomy and gas tamponade. This study evaluated the size of macular hole and the rate of anatomical and functional success of surgery. To assess dimensions of macular hole, confocal laser scanning tomography was employed.

Age at the onset showed a significant increase in relation to myopic refraction and axial length (r = 0.689, p <0.0001; r = 0.723, p <0.0001). Mean age was 52.1 (SD 10.3) years in eyes with axial length of 26.0 mm and longer, 64.5 (8.5) years in eyes with 23.0 to 25.99 mm, and 69.8 (5.7) years in eyes with shorter than 23.0 mm. In stage III macular holes, mean area of macular hole was 0.291 (0.134) mm(2) in eyes with 26.0 mm and longer, 0.283 (0.170) mm(2) in eyes with 23.0 to 25.99 mm, and 0.296 (0.160) mm(2) in eyes with shorter than 23.0 mm. No significant difference was found in area, volume, and depth of macular hole, and area of cuff and retinal striae among the three groups. Overall anatomical success rate and logMAR visual improvement in stage III macular holes were 100% (19 of 19 eyes) and -0.575 (0.174) in eyes with 26.0 mm and longer, 100% (16 of 16 eyes) and -0.536 (0.174) in eyes with 23.0 to 25.99 mm, and 95% (40 of 42 eyes) and -0.599 (0.201) in eyes with shorter than 23.0 mm; there was no significant difference.

Macular hole develops in eyes with the severer myopia at the younger age. Myopic refraction appears not to influence the size and surgical outcomes of macular holes. Further investigation on more cases is needed.