Purpose: A case-control study was conducted to identify possible risk factors for idiopathic macular holes.
Methods: One hundred ninety-eight patients with idiopathic macular holes and 1,023 control subjects were identified at five clinical centers. Data were obtained through interviews, clinical examinations, and laboratory analyses of blood specimens.
Results: One hundred forty-three (72%) affected patients were women. Very few of a broad array of possible risk factors were statistically significant. In a logistic regression model that included both genders, higher plasma fibrinogen levels (P = .0007) and a history of glaucoma (P = .04) were associated with an increased risk of idiopathic macular holes. When the same model was used for women, with estrogen use and parity added as variables, a higher fibrinogen level (P = .002) was positively associated, and estrogen use (P = .04) was negatively associated with risk of macular holes.
Conclusions: Of the two factors that stood out as possible risk factors for idiopathic macular holes, the increased risk for women has long been recognized. The association with fibrinogen level was unexpected, and it is unclear whether this is a chance finding or whether higher levels of fibrinogen can increase susceptibility to the forces of vitreous traction, perhaps by compromising the macular blood supply or by some yet unexplained mechanism.