Effect of the vitreous on the prognosis of full-thickness idiopathic macular hole.

We studied 112 eyes with full-thickness idiopathic macular holes (mean follow-up period, 5.7 years) to ascertain the effect of the vitreous on prognosis. Eyes were divided as follows: group 1, 58 eyes with no posterior vitreous detachment; group 2, 25 eyes with no posterior vitreous detachment initially and development of complete posterior vitreous detachment during follow-up; and group 3, 29 eyes with complete posterior vitreous detachment. In group 1, the macular hole enlarged in 37 eyes (64%), and the surrounding retinal detachment enlarged in 29 (50%); visual acuity decreased in 20 eyes (34%) by two or more Snellen lines. These percentages were significantly higher than in group 3 (14%, 10%, and 10%; P = .01, P = .01, and P = .03, respectively). Eyes with a full-thickness macular hole with no posterior vitreous detachment may have a greater risk of enlargement of the macular hole and surrounding retinal detachment, and thus a worse prognosis than eyes with posterior vitreous detachment.