Clinical characteristics of atrophic macular hole in pathologic myopia: A multicenter study

This study aims to describe and analyze the clinical characteristics of atrophic macular hole (AMH), a severe complication in patients with pathologic myopia (PM).

A multicenter, retrospective analysis was conducted involving 17 patients (17 eyes) diagnosed with AMH and 52 patients (52 eyes) diagnosed with simple macular hole (SMH) in PM from January 2023 to December 2023. Clinical data and multimodal images were collected. The age, gender, spherical equivalent (SE), axial length (AL), and best-corrected visual acuity (BCVA) of patients with AMH were described and their imaging characteristics analyzed.

Of the 17 patients diagnosed with AMH, 15 (88.24 %) were female; the mean age was 64.59±12.61 years; the SE was -17.85±4.15 D; the AL was 30.40±1.67 mm; and the BCVA was 1.30 (1.00, 1.35) logMAR. Eleven eyes (64.71 %) exhibited myopic foveoschisis, seven eyes showed choroidal neovascularization (Fuchs spot), one eye had a concomitant epiretinal membrane, and no cases of retinal detachment involving the macula were observed. Axial length and neovascularization were significant correlates of BCVA in AMH patients (P < 0.05). Compared with SMH in PM, patients with AMH were older (t = 2.247, P = 0.028) and had worse BCVA (Z = 375, P = 0.037); no significant differences were found between the two groups in terms of gender, SE, and AL (P > 0.05).

We propose the term "atrophic macular hole" to describe a condition resembling a macular hole accompanied by atrophy of the RPE and choroid, caused by progressive degeneration of the outer retina or traction of the eyeball, which severely impairs central vision in patients.