Incidence and Risk Factors of Full-Thickness Macular Hole in Fellow Eyes

To estimate the incidence of full-thickness macular hole (FTMH) bilateralization, identify risk factors for development in the fellow eye, and compare surgical outcomes between first and second eyes.

Retrospective consecutive case series.

Patients with unilateral idiopathic FTMH.

Clinical records and spectral-domain OCT were reviewed to assess FTMH characteristics, bilateralization, and vitreoretinal interface status in the fellow eye, including posterior vitreous detachment (PVD), vitreomacular traction (VMT), epiretinal membrane, and lamellar hole.

Incidence of fellow-eye FTMH, time to bilateralization, risk factors, and surgical outcomes.

Among 576 patients (mean age, 67.2 ± 8.7 years), 34 (5.9%) experienced a fellow-eye FTMH over a mean follow-up of 27.3 ± 25.3 months. The cumulative incidence was 4% ± 1% at 1 year and 12% ± 2% at 5 years. Eyes with VMT had a markedly higher risk, reaching 19% ± 6% at 1 year and 27% ± 7% at 2 years, and developed FTMH earlier than eyes without VMT. In multivariable analysis, VMT was the strongest independent predictor of bilateralization (odds ratio, 12.9; 95% confidence interval, 3.5-47.2; P < 0.001). Axial length and high myopia were not associated with fellow-eye FTMH. Fellow-eye holes were smaller and had better visual acuity at diagnosis, but final visual acuity and closure rates were comparable to those of the first eyes.

Fellow-eye FTMH occurs in ∼12% of patients at 5 years. Vitreomacular traction and the absence of PVD are the principal risk factors, whereas high myopia does not increase the risk of bilateralization. Close surveillance is warranted, particularly within the first 2 years in eyes with VMT.

The authors have no proprietary or commercial interest in any materials discussed in this article.