0
Research Letters |

Percentage of Fellow Eyes That Develop Full-Thickness Macular Hole in Patients With Unilateral Macular Hole FREE

Kazuyuki Kumagai, MD; Nobuchika Ogino, MD; Masanori Hangai, MD; Eric Larson, PhD
[+] Author Affiliations

Author Affiliations: Shinjo Ophthalmologic Institute (Drs Kumagai and Ogino) and Miyazaki Prefectural Nursing University (Dr Larson), Miyazaki, and Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto (Dr Hangai), Japan.


Arch Ophthalmol. 2012;130(3):393-394. doi:10.1001/archopthalmol.2011.1427.
Text Size: A A A
Published online

Patients with a unilateral macular hole (MH) have an increased risk of developing an MH in the fellow eye.14 However, to our knowledge, the incidence of developing an MH in the fellow eye has not been analyzed in a large cohort of eyes after macular hole surgery. The purpose of this study was to determine the probability of developing a full-thickness MH in the fellow eyes of patients with a unilateral MH.

A retrospective longitudinal study of 1082 patients with a unilateral, idiopathic, full-thickness MH who underwent vitrectomy by one of us (N.O.) between October 1990 and December 2010 was conducted. All of the patients were confirmed to have a unilateral full-thickness MH at the initial visit by dilated indirect slitlamp biomicroscopy. Patients with any other fundus diseases or history of ocular trauma or surgery in either eye were excluded.

Kaplan-Meier life-table analysis was used to estimate the risk of developing an MH in the fellow eye. In addition, the cumulative incidence of bilateral MHs was fit to a hyperbolic function: G = Gmax × T /(Tm + T), where the visual gain (G) was defined as the preoperative best-corrected visual acuity minus postoperative best-corrected visual acuity in logMAR units; the maximum visual gain (Gmax) was defined as the preoperative best-corrected visual acuity minus final best-corrected visual acuity in logMAR units; the average visual gain was plotted as a function of the postoperative time (T) in months; and Tm was defined as the postoperative time required to reach one-half Gmax. This equation was found earlier to describe the recovery of visual acuity after treatment of different macular diseases.5

There were 394 men and 688 women in the study. The mean (SD) age at the initial surgery was 64.2 (8.3) years (range, 21-95 years). The mean (SD) follow-up period was 71.8 (49.6) months (range, 6-246 months).

Nine hundred sixty patients (88.7%) remained with a unilateral MH (unilateral group) and 122 patients (11.3%) developed an MH in the fellow eye (bilateral group). The sex distribution, age at onset in the first eye, and axial length in the first eye were not significantly different between the unilateral and bilateral groups (Table).

Table Graphic Jump LocationTable. Baseline Characteristics of Study Patients

We defined the interval between the onset of the first MH and that in the second eye as the bilateral interval. If the second eye developed an MH within 1 month of onset in the first eye, the bilateral interval was set to 0. The mean (SD) bilateral interval among all patients was 26.1 (28.0) months (range, 0-122 months). The difference in the mean bilateral interval between men and women was not significant (P = .38). The age at onset of an MH in the first eye and its axial length were not significantly correlated with bilateral interval.

The risk of the fellow eye developing an MH estimated by the Kaplan-Meier method was 11.6% at 5 years and 16.7% at 10 years. The cumulative incidence of bilaterality can be described by the following hyperbolic function: y = 2.6 + 29.8 x/(130.1 + x), with R2 = 0.99 (Figure). Curve-fit analysis showed that the estimated risk of the fellow eye developing an MH was 12.0% at 5 years and 16.9% at 10 years.

Place holder to copy figure label and caption
Graphic Jump Location

Figure. The cumulative incidence of macular hole (MH) bilaterality can be described by a hyperbolic function, y = 2.6 + 29.8 x/(130.1 + x), with R2 = 0.99. Curve-fit analysis showed that the estimated risk of MH in the fellow eye was 12.0% at 5 years and 16.9% at 10 years.

Earlier retrospective studies reported that the incidence of developing an MH in the fellow eye with or without a posterior vitreous detachment was 22% for a mean follow-up of 57 months (37 patients)1 and 13% within 48 months (340 patients).2 Ezra et al3 reported that the incidence of developing an MH in the fellow eye without a posterior vitreous detachment (114 patients) was 15.6% at 5 years by Kaplan-Meier analysis. Although the long-term incidence of developing an MH in the fellow eye may depend on the patient demographic characteristics and vitreoretinal interface features, our large-scale study showed that the cumulative incidence of bilaterality was well fit by a hyperbolic function. The findings of the curve-fit analysis suggested that the estimated risk was 21.9% at 20 years and 24.5% at 30 years, although these estimates will have to be confirmed by longer longitudinal studies. Because the appearance of the vitreoretinal interface in spectral-domain optical coherence tomographic images is associated with the risk of developing an MH in the fellow eye,6 further studies are required to determine the long-term risk in the fellow eye based on spectral-domain optical coherence tomographic features.

Correspondence: Dr Kumagai, Shinjo Ophthalmologic Institute, 889-1 Mego Shimokitakata-machi, Miyazaki, Japan 880-0035 (ganka@kamiiida-hp.jp).

Author Contributions: Dr Kumagai had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure: None reported.

Bronstein MA, Trempe CL, Freeman HM. Fellow eyes of eyes with macular holes.  Am J Ophthalmol. 1981;92(6):757-761
PubMed
Lewis ML, Cohen SM, Smiddy WE, Gass JD. Bilaterality of idiopathic macular holes.  Graefes Arch Clin Exp Ophthalmol. 1996;234(4):241-245
PubMed   |  Link to Article
Ezra E, Wells JA, Gray RH,  et al.  Incidence of idiopathic full-thickness macular holes in fellow eyes: a 5-year prospective natural history study.  Ophthalmology. 1998;105(2):353-359
PubMed   |  Link to Article
Chew EY, Sperduto RD, Hiller R,  et al.  Clinical course of macular holes: the Eye Disease Case-Control Study.  Arch Ophthalmol. 1999;117(2):242-246
PubMed
Kumagai K, Ogino N, Larson E. Mathematical function describing visual gain curves following vitrectomy for different macular diseases.  Jpn J Ophthalmol. 2011;55(2):89-92
PubMed   |  Link to Article
Kumagai K, Hangai M, Larson E, Ogino N. Vitreoretinal interface and foveal deformation in asymptomatic fellow eyes of patients with unilateral macular holes.  Ophthalmology. 2011;118(8):1638-1644
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. The cumulative incidence of macular hole (MH) bilaterality can be described by a hyperbolic function, y = 2.6 + 29.8 x/(130.1 + x), with R2 = 0.99. Curve-fit analysis showed that the estimated risk of MH in the fellow eye was 12.0% at 5 years and 16.9% at 10 years.

Tables

Table Graphic Jump LocationTable. Baseline Characteristics of Study Patients

References

Bronstein MA, Trempe CL, Freeman HM. Fellow eyes of eyes with macular holes.  Am J Ophthalmol. 1981;92(6):757-761
PubMed
Lewis ML, Cohen SM, Smiddy WE, Gass JD. Bilaterality of idiopathic macular holes.  Graefes Arch Clin Exp Ophthalmol. 1996;234(4):241-245
PubMed   |  Link to Article
Ezra E, Wells JA, Gray RH,  et al.  Incidence of idiopathic full-thickness macular holes in fellow eyes: a 5-year prospective natural history study.  Ophthalmology. 1998;105(2):353-359
PubMed   |  Link to Article
Chew EY, Sperduto RD, Hiller R,  et al.  Clinical course of macular holes: the Eye Disease Case-Control Study.  Arch Ophthalmol. 1999;117(2):242-246
PubMed
Kumagai K, Ogino N, Larson E. Mathematical function describing visual gain curves following vitrectomy for different macular diseases.  Jpn J Ophthalmol. 2011;55(2):89-92
PubMed   |  Link to Article
Kumagai K, Hangai M, Larson E, Ogino N. Vitreoretinal interface and foveal deformation in asymptomatic fellow eyes of patients with unilateral macular holes.  Ophthalmology. 2011;118(8):1638-1644
PubMed   |  Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles