A prospective natural history study and kinetic ultrasound evaluation of idiopathic macular holes

The role of vitreoretinal traction in the macular region as a causative factor for the development of idiopathic macular holes is widely accepted. The purpose of this study is to provide a prospective evaluation of patients with idiopathic macular holes to determine the risk of hole formation in the fellow eye.

The authors performed a prospective study of 50 patients with unilateral idiopathic macular holes combining complete ocular examination, including slit-lamp biomicroscopy, with kinetic B-scan ultrasound evaluation of the status of the vitreoretinal interface. Natural history data were obtained by follow-up examinations performed at 3-month intervals throughout the course of the study.

During a median follow-up of 33 months, a full-thickness macular hole developed in 1 (2%) of 46 normal fellow eyes. Full-thickness holes also developed in three (75%) of the four eyes that had premacular hole changes (stages 1A and 1B) in the fellow eye on initial examination. All macular holes in fellow eyes occurred within 24 months of entry into the study. Kinetic ultrasound evaluation determined that fellow eyes with separation of the posterior hyaloid membrane in the foveal region were protected from future macular hole development. Those patients with attachment of the posterior hyaloid membrane in both eyes were at highest risk of holes forming in the fellow eye. Patients with posterior hyaloid membrane separation in the macular hole eye only, with an attached vitreous in the fellow eye, were at intermediate risk.

The authors suggest that fellow eyes in patients with unilateral idiopathic macular holes have a relatively favorable natural history and that kinetic ultrasound examination may help determine which of these fellow eyes is at highest risk for full-thickness macular holes developing.