Risk Factors for Progression of Vitreomacular Traction to Macular Hole

Abstract

Purpose: To evaluate the clinical and optical coherence tomography (OCT) characteristics associated with progression of vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) and lamellar macular hole (LMH). Methods: A retrospective cohort study of patients with an OCT-confirmed diagnosis of idiopathic VMT and 6 or more months of follow-up was performed. Clinical data included age, sex, race, systemic comorbidities, hormone replacement therapy, corrected visual acuity (VA), subjective visual symptoms, OCT signs, and the presence of or progression to FTMH or LMH. Results: Of the 287 eyes with VMT, 48 (16.7%) progressed to MH. Twelve eyes (4.2%) progressed to LMH, and 36 eyes (12.5%) progressed to FTMH. Female sex ( P = .02), myopic refractive status in phakic eyes ( P = .02), subjective decreased VA ( P = .01), and the presence of an inner segment–outer segment junction disruption on OCT ( P = .003) were risk factors for progression from VMT to FTMH. Subjective metamorphopsia was a risk factor for progression to FTMH ( P = .001) and LMH ( P = .01). In a subgroup analysis, patients who had an FTMH in the fellow eye were significantly more likely to have VMT progress to FTMH in the study eye (24.0% vs 8.7%; P = .04). Having an LMH in the fellow eye was not a risk factor for progression to LMH in the study eye ( P = .47). Conclusions: Risk factors were found for the progression of VMT to MH that may be clinically relevant for risk-stratifying patients presenting with VMT.