Outcomes and predictive factors in bilateral macular holes

Purpose: To evaluate the incidence, risk factors, outcomes, and visual prognosis in patients with bilateral macular holes repaired surgically with indocyanine green (ICG) - assisted internal limiting membrane (ILM) peeling in our population. Design: Retrospective, multisurgeon, nonrandomized, noncomparative case series. Participants: Eighty-two patients were identified who underwent bilateral macular hole surgery with ILM peeling without other vision-limiting pathologic features. Methods: All patients underwent bilateral macular hole surgery at a single-site, multisurgeon center with preoperative and postoperative optical coherence tomography (OCT) characterization and ICG-assisted ILM peeling during surgery with intraocular gas tamponade. Main Outcome Measures: Comparison of the closure and reopening rate, prognosis, change in visual acuity, and family history for patients undergoing bilateral surgery. Results: Eight-two patients met the inclusion criteria (164 eyes). Nineteen patients (22.6%) had asymptomatic vitreomacular adhesion by OCT in the fellow eye at the time of presentation of macular hole in the first eye. There was a mean interval of 19.4 months between the first and fellow eye macular holes and a male-to-female ratio of 1:2.42. Surgical closure rate was 89% with the first macular hole surgery and 98.8% with the second surgery. Sex, family history, and duration of hole symptom were not found to be associated with risk of macular hole recurrence. Symptom duration of less than 1 year and earlier macular hole stage yielded the best visual acuity after successful surgical repair. Conclusions: Patients with bilateral macular holes may consider undergoing bilateral macular hole surgery to improve visual acuity. Successful closure rates of bilateral macular holes with ILM peeling in this series are better than those reported previously without consistent ILM peeling. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.