The impact of hormonal fluctuations and the efficacy of targeted hormonal interventions in improving macular hole outcomes.

Background: Macular hole formation is influenced by vitreoretinal dynamics, with hormonal status playing a critical role in retinal stability. Reduced estrogen and testosterone levels in postmenopausal women and men with hypogonadism have been linked to increased macular hole severity. This study investigates the impact of hormonal fluctuations and the efficacy of targeted hormonal interventions in improving macular hole outcomes. Methods: A total of 118 participants were divided into four groups: premenopausal women (n = 30), postmenopausal women (n = 35), men with normal testosterone levels (n = 28), and men with hypogonadism (n = 25). Hormonal profiles were measured using LC-MS/MS, and macular hole severity was assessed with SD-OCT. Hormonal interventions included estrogen replacement therapy (ERT) and testosterone supplementation. Statistical analysis involved ANOVA, chi-square tests, and regression models. Results: Participants with low hormone levels exhibited larger macular holes and higher progression rates. Postmenopausal women without ERT and men with hypogonadism had progression rates of 55 and 60%, respectively, while those receiving hormonal interventions showed reduced rates of 30 and 35%. Hormonal interventions significantly improved macular hole closure rates (70% in ERT and 65% in testosterone groups) and visual acuity gains (2.8 lines and 2.5 lines, respectively). Subgroup analysis indicated better outcomes in early postmenopausal women and younger men, while diabetic participants showed poorer results. Conclusion: Hormonal fluctuations significantly impact macular hole progression, and hormonal interventions can enhance closure rates and visual outcomes. Early hormonal therapy initiation is associated with better results, highlighting the potential for personalized treatment strategies.