Rate of progression of idiopathic full-thickness macular holes before surgery

To evaluate the spontaneous change in size over the time of idiopathic full-thickness macular holes (IFTMHs) using optical coherence tomography (OCT).

This retrospective observational study included 24 eyes of 24 consecutive patients waiting for IFTMH surgery. On OCT horizontal B-scan passing through the center of the fovea, the minimum linear diameter (MLD), the basal diameter (BD), and the presence of vitreomacular adhesion (VMA) were evaluated. The mean total and daily MLD and BD variations were calculated as both absolute and percentage values.

The MLD and BD size increase was statistically significant (P < 0.0001). The MLD size increase was significantly greater for small (<250 μm) versus both medium (≥250 to ≤400 μm) and large (>400 μm) IFTMHs in all analysis: the total absolute (P = 0.0248), the daily absolute (P = 0.0186), the total percentage (P = 0.0020), and the daily percentage (P = 0.0008) variations. For the BD, the significance between the same groups was achieved only in the daily percentage change (P = 0.0220). The presence of VMA did not influence the amount of MLD and BD increase. The rate of increase was dependent on the size of hole at presentation (MLD: small: 1.67 microns per day; medium: 0.61 microns per day; large: 0.44 microns per day).

Both MLD and BD increase over the time in IFTMHs. There is a significantly greater rate of increase in hole size in smaller holes compared with larger. Therefore, prioritisation for small IFTMH may be justified.