Prevalence and Surgical Outcomes of Macular Hole in Eyes with Age-Related Macular Degeneration Prethy Rao, MD, MPH, 1 Yoshihiro Yonekawa, MD, 1,2 Ashkan M. Abbey, MD, 1,2,3 Aparna A. Shah, MD, 1 Jeremy D. Wolfe, MD, 1,2 Lisa J. Faia, MD 1,2 Purpose: To report the prevalence and surgical outcomes of macular holes (MHs) in eyes with age-related macular degeneration (AMD). Design: Interventional, retrospective, consecutive case series. Participants: Patients with MH and concurrent non-neovascular (NNV) or neovascular (NV) AMD. Methods: The records of 27 912 patients diagnosed with AMD between 2009 and 2014 at Associated Retinal Consultants were reviewed. Demographic data, visual acuity (VA), funduscopic examination, and optical coher- ence tomography were reviewed in those with a concurrent diagnosis of MH. Main Outcome Measures: The VA and MH closure status. Results: A total of 15 196 patients with NNV and 12 716 patients with NV AMD were identified. A total of 199 eyes (0.7%) had MHs (160 NNV [1.1%]; 39 NV [0.3%]). Mean time to diagnosis of MH after the initial visit was 11.2 months (7.1 NNV; 24.8 NV). A total of 127 eyes underwent surgical repair (106 NNV; 21 NV). The final closure rate in those who underwent vitrectomy was 89.8% (91.5% NNV; 81.0% NV) and 25.0% in those who were observed (18.5% NNV, P < 0.0001; 44.4% NV, P ¼ 0.02). Preoperative logarithm of the minimum angle of resolution VAs in NNV and NV AMD was 0.80.4 and 0.80.5, respectively, and final VA was 0.60.5 (P < 0.001) and 0.90.6 (P ¼ 0.52), respectively. Mean follow-up time was 5.0 years. Conclusions: The prevalence of MH was higher in eyes with NNV AMD than in those with NV AMD. The surgical closure rate was comparable in both groups, but VA improvement reached statistical significance only in the NNV AMD group. Ophthalmology Retina 2016;-:1e7 ª 2016 by the American Academy of Ophthalmology Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries and has an esti- mated worldwide prevalence of 8.7%. 1 Complications include geographic atrophy (GA), choroidal neovascularization, hemorrhage, exudation, retinal pigment epithelial (RPE) detachment or tear, and fibrosis with profound central vision loss. 2 Non-neovascular (NNV) AMD currently is managed with vitamin supplementation if certain characteristics are met. 3 Neovascular (NV) AMD is treated with intravitreal injections of anti-vascular endo- thelial growth factor (VEGF) agents. 4 Macular hole (MH) also is a prevalent macular pathology. Full-thickness macular holes (FTMHs) are visually significant disruptions of foveal anatomy with an estimated incidence of 0.02% to 0.8% in those aged >40 years. 5,6 Originally described by Gass in 1988, the pathophysiologic mechanism of MH formation involves posterior hyaloid contraction, perifoveal vitreous detachment, and anterior-posterior vitre- oretinal forces. 7,8 Current treatment options include observa- tion, pharmacologic vitreolysis, and vitrectomy with or without internal limiting membrane (ILM) peeling. 9,10 Lamellar MHs are partial-thickness defects in the neurosen- sory retina, which are generally less visually significant. 11 Our understanding and treatment of AMD and MH as individual entities have significantly improved over the years. However, little is known regarding eyes that harbor both AMD and MH. 12e14 Many questions remain unan- swered, such as the prevalence, treatment response, and visual outcomes. The purpose of this study was to determine the prevalence of MHs in both NV and NNV AMD and to present the long-term surgical outcomes. Methods This was a single-center, interventional, consecutive, comparative, retrospective review of all medical records that contained diag- nostic codes of a “macular hole” and “age-related macular degeneration” from January 1, 2009, to November 30, 2014, at the Associated Retinal Consultants. Institutional review board approval was granted. The study complied with the Health Insur- ance Portability and Accountability Act of 1996 and conformed to the tenets of the Declaration of Helsinki. Eligibility Inclusion criteria included a diagnosis of an MH and concurrent AMD. Exclusion criteria were: patients who (1) developed AMD after MH diagnosis, (2) underwent MH surgery at an outside fa- cility, (3) had prior vitreoretinal surgery for another pathology before or concurrently with the MH diagnosis, (4) had other con- current macular or vaso-occlusive pathology that may confound the 1 Ó 2016 by the American Academy of Ophthalmology Published by Elsevier Inc. http://dx.doi.org/10.1016/j.oret.2016.09.014 ISSN 2468-6530/16