Inner foveal irregularities after vitreomacular detachment: a morphologic risk factor for macular hole formation in the fellow eye

Purpose: To assess the morphologic risk of full thickness macular hole (FTMH) formation in the fellow eye based on posterior vitreous detachment (PVD) status and preceding vitreomacular interface changes using optical coherence tomography (OCT) data of the fellow eye. Methods: The natural history of fellow eyes of patients with unilateral FTMH was reviewed for tractional maculopathies, symmetry of the foveal contour, inner and outer retinal irregularities and PVD status on spectral domain OCT. PVD was classified as incomplete (iPVD= vitreomacular adhesion or traction) or macular (mPVD= vitreomacular detachment). Foveal contour changes were classified as inner foveal irregularity (IFI) if mPVD was present without evidence of other tractional maculopathies. Results: 72 eyes of 72 consecutive patients were included. 9 (12.5%) developed FTMH during a mean follow-up of 19.1 ± 23.8 (range: 3.0 - 133.0) months. iPVD at baseline was not associated with a higher incidence of FTMH at follow-up (10.5% mPVD vs. 14.7% iPVD, p=0.727). 9 of 38 eyes (23.7%) with mPVD had IFI at baseline. IFI was a risk factor for FTMH formation after mPVD (p=0.033, OR=14.0). The cumulative risk of IFI-FTMH conversion was 16.7% at 12 months and 44.4% at 24 months. Conclusion: IFI can be frequently documented in the fellow eyes of patients with FTMH and may be an early morphologic risk factor for FTMH formation after mPVD in the context of prior fellow eye involvement