Is axial length a risk factor for idiopathic macular hole formation?

Abstract

Current theories for macular hole formation implicate antero-posterior and tractional forces at the vitreofoveal interface. It is thought that localized perifoveal defects enlarge from centrifugal forces acting about the axis of ocular rotation. If this is true, eyes with longer axial lengths should have an increased incidence of macular holes. The aim of this study was to determine if axial length is a risk factor for macular hole development. The study group comprised 40 patients with refractive errors from hyperopia to myopia with stage 3 and 4 idiopathic macular holes. Controls matched for age, gender and spherical equivalent (SE) were used for statistical comparison. Axial length (AL) was analyzed using SPSS 13.0 statistical software and compared using Student's t test. P < 0.05 was considered significant. SE ranged from -8.88 to +3.63 dioptres in the macular hole group and -8.50 to +3.63 in controls. In the macular hole group, mean AL ± standard deviation was 23.62 ± 1.20 mm (21.81-27.51); in controls, 23.09 ± 1.16 mm (21.31-26.58). Univariate analysis showed that higher AL is associated with macular hole formation. The mean difference in AL was 0.531 mm (95 % confidence interval -0.1596 to -0.9024). Two-tailed t test: P < 0.006. This study showed that increasing ocular AL is significantly associated with macular holes. Dynamic forces at the macula would be greater in these eyes suggesting this may play a causative role in macular hole formation.

Wider Retinal Artery Trajectories in Eyes with Macular Hole Than in Fellow Eyes of Patients with Unilateral Idiopathic Macular Hole

“…For example, what causes the traction by the posterior hyaloid on the retinal surface, and how does the fragility and stiffness of the retina affect the formation of a MH. Because a MH has a higher incidence in eyes with longer axial lengths (myopia) and in older individuals, especially women, we can reasonably assume that the structure of the eye and changes in the structure with increasing age could be involved in the pathogenesis of MHs [ 9 – 11 ]. For example, it has been shown that the retinal thickness decreases with increasing age which should make the retinas of older individuals more susceptible to MH formation [ 11 ].…”

“…For example, it has been shown that the retinal thickness decreases with increasing age which should make the retinas of older individuals more susceptible to MH formation [ 11 ]. In addition, the incidence of MHs is higher in highly myopic eyes than in emmetropic eyes [ 9 ]. This is most likely because myopic eyes have longer axial lengths and thinner retinas.…”

Delayed macular hole formation after demarcation laser photocoagulation for subclinical retinal detachment

“…Trauma, tractional forces at the vitreofoveal interface, and aging have all been implicated in development of macular hole. Recently, eyes with increased axial length and thus greater dynamic forces at the macula have also been associated with increased macular hole formation 6. We present a series of three patients who developed an idiopathic macular hole after DLP.…”

Inner Segment Ellipsoid Band and Cone Outer Segment Tips Changes Preceding Macular Hole Development in a Young Patient

“…Macular hole (MH) is an idiopathic condition that in most cases is related to posterior vitreous detachment (PVD) and is mainly seen in the elderly. The minority of cases are observed in younger patients with a history of blunt ocular trauma as well as in myopic patients after laser assisted in situ keratomileusis (LASIK) surgery [ 1 , 2 ].…”