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D'Albenzio A, Komici K, Affatato M, Castelluzzo AM, De Turris S, Tonti E, Guerra G, Roberto dell'Omo. Vitreous cortex remnants in patients with rhegmatogenous retinal detachment: A systematic review and meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00121-8. [PMID: 39341231 DOI: 10.1016/j.survophthal.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 09/30/2024]
Abstract
The terminology "vitreous cortex remnants" (VCR) indicates the outermost lamellae of vitreous cortex that remains attached to the retinal surface as a consequence of vitreoschisis. The relevance of VCR removal in eyes with rhegmatogenous retinal detachment (RRD) is unknown. We conducted a review from January 1, 2000, to July 30, 2023, examining 1493 eyes. Outcome measures included: prevalence of VCR, relationship between VCR and detachment recurrence due to proliferative vitreoretinopathy (PVR), and relationship between VCR and epiretinal membrane (ERM) formation. A meta-analysis was performed with data reported as odds ratios (OR) or mean difference and 95 % confidence intervals. Prevalence of macular and peripheral VCR was 53.4 and 46.8, respectively, with an overall VCR prevalence of 50.8 (95 % CI 42.6, 59.1) Given the scarcity of available data, meta-analysis regarding the relationship between peripheral VCR and redetachment due to PVR was not feasible. The odds of developing ERM were not statistically different between eyes that had had macular VCR removal vs. eyes that had not (log OR -0.08 [95 % CI -1.06, 0.89 p= 0.89]. Additional prospective studies are required to verify whether removal of VCR may reduce the odds of recurrence of RRD due to PVR and the development of ERM.
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Affiliation(s)
- Andrea D'Albenzio
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Marzia Affatato
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Angela Maria Castelluzzo
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Serena De Turris
- Health care service, Regione Molise, District 1, Campobasso, Italy
| | - Emanuele Tonti
- Health care service, Regione Molise, District 1, Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Roberto dell'Omo
- Department of Medicine and Health Sciences " Vincenzo Tiberio", University of Molise, Campobasso, Italy.
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Li H, Liu Y, Yao J, Zheng J, Yang Y, Li H, Wang F, Liu Y. CLINICOPATHOLOGIC CHANGES OF VITREOMACULAR INTERFACE IN IDIOPATHIC EPIRETINAL MEMBRANE WITH DISORGANIZATION OF RETINAL INNER LAYERS. Retina 2024; 44:1521-1528. [PMID: 39167573 DOI: 10.1097/iae.0000000000004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To compare the pathological characteristics of the vitreomacular interface of the idiopathic epiretinal membrane with and without disorganization of retinal inner layers (DRIL) and to correlate with clinical data. METHODS In this clinicopathologic study, the samples of epiretinal membrane and internal limiting membrane were extracted from DRIL(+) (19 eyes) and DRIL(-) (22 eyes) idiopathic epiretinal membrane eyes. Ultrathin series sectioning for transmission electron microscopy was observed and correlated with surgery status and prognosis. RESULTS All idiopathic epiretinal membrane eyes presented fibrocellular membranes accompanied by vitreous collagen, glial cells, and myofibroblasts, regardless of association with DRIL. A robust signal indicative of Collagen Type VI was observed in eyes DRIL(-), whereas Collagen Type I was discovered in DRIL eyes. Cell debris and microvascular basement membrane were seen on the retinal side of DRIL eyes and a larger cell count on the vitreous side. These have more intraoperative complications and less surgery benefit. CONCLUSION Although internal limiting membrane peeling seems important, the histopathologic findings underscore the potential for retinal injury in DRIL(+) idiopathic epiretinal membrane eyes. This suggests that further research is needed to investigate individual preoperative assessment and to modify surgical procedures.
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Affiliation(s)
- Huanhuan Li
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
| | - Yan Liu
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
| | - Jinghong Yao
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
| | - Jiusheng Zheng
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
| | - Yanting Yang
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
| | - Hui Li
- Department of Ophthalmology, Shanghai 10th People's Hospital, Tongji University, Shang Hai, China ; and
| | - Fang Wang
- Department of Ophthalmology, Shanghai 10th People's Hospital, Tongji University, Shang Hai, China ; and
- Shanghai Purui Eye Hospital, Purui Eye Group, Shang Hai, China
| | - Yao Liu
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, China
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Lange C, Boneva S, Wieghofer P, Sebag J. Hyalocytes-guardians of the vitreoretinal interface. Graefes Arch Clin Exp Ophthalmol 2024; 262:2765-2784. [PMID: 38568222 PMCID: PMC11377362 DOI: 10.1007/s00417-024-06448-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 09/06/2024] Open
Abstract
Originally discovered in the nineteenth century, hyalocytes are the resident macrophage cell population in the vitreous body. Despite this, a comprehensive understanding of their precise function and immunological significance has only recently emerged. In this article, we summarize recent in-depth investigations deciphering the critical role of hyalocytes in various aspects of vitreous physiology, such as the molecular biology and functions of hyalocytes during development, adult homeostasis, and disease. Hyalocytes are involved in fetal vitreous development, hyaloid vasculature regression, surveillance and metabolism of the vitreoretinal interface, synthesis and breakdown of vitreous components, and maintenance of vitreous transparency. While sharing certain resemblances with other myeloid cell populations such as retinal microglia, hyalocytes possess a distinct molecular signature and exhibit a gene expression profile tailored to the specific needs of their host tissue. In addition to inflammatory eye diseases such as uveitis, hyalocytes play important roles in conditions characterized by anomalous posterior vitreous detachment (PVD) and vitreoschisis. These can be hypercellular tractional vitreo-retinopathies, such as macular pucker, proliferative vitreo-retinopathy (PVR), and proliferative diabetic vitreo-retinopathy (PDVR), as well as paucicellular disorders such as vitreo-macular traction syndrome and macular holes. Notably, hyalocytes assume a significant role in the early pathophysiology of these disorders by promoting cell migration and proliferation, as well as subsequent membrane contraction, and vitreoretinal traction. Thus, early intervention targeting hyalocytes could potentially mitigate disease progression and prevent the development of proliferative vitreoretinal disorders altogether, by eliminating the involvement of vitreous and hyalocytes.
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Affiliation(s)
- Clemens Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany.
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Wieghofer
- Cellular Neuroanatomy, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA.
- Doheny Eye Institute, UCLA, Pasadena, CA, USA.
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Choi J, Kim SJ, Kang SW, Son KY, Hwang S. Macular hole with epiretinal proliferation: diagnostic value of en-face optical coherence tomography and clinical characteristics. Graefes Arch Clin Exp Ophthalmol 2024; 262:2461-2470. [PMID: 38499794 DOI: 10.1007/s00417-024-06446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To elucidate the clinical features and surgical outcomes of full-thickness macular hole (FTMH) with epiretinal proliferation (EP) diagnosed by both en-face and B-mode optical coherence tomography (OCT). METHOD This retrospective cohort study classified idiopathic FTMHs into two groups, based on B-scan and en-face OCT imaging: FTMH with EP (EP group) and without EP (non-EP group). The preoperative features, as well as postoperative outcomes up to 12 months, were compared between the two groups. RESULT Among 318 eyes of idiopathic FTMH that met the inclusion criteria, 59 eyes (18.6%) were in the EP group, and others were in the non-EP group. In 9 eyes (15.3%) out of the EP group, EP was not detected in the preoperative B-mode OCT but was identified through the en-face OCT. Baseline features showed a higher male proportion (47.5% vs. 27.8%, P = 0.005) and a lower incidence of vitreofoveal traction (P < 0.001) in the EP group than in the non-EP group. The EP group showed worse visual recovery than the non-EP group (- 0.23 vs. - 0.41 logarithm of the minimum angle of the resolution at 12 months, P = 0.001). CONCLUSION The en-face OCT enhances diagnostic accuracy of EP in FTMH eyes, especially in the case with smaller extent of EP. Eyes with FTMH with EP showed a worse visual recovery than FTMH without EP.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medial Center, Kyung Hee University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Holzwarth J, Krohne TU, Lommatzsch A, Priglinger SG, Hattenbach LO. [Epiretinal membrane: diagnostics, indications and surgical treatment]. DIE OPHTHALMOLOGIE 2024; 121:443-451. [PMID: 38831204 DOI: 10.1007/s00347-024-02055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024]
Abstract
An epiretinal membrane (ERM) is a frequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. A distinction is made between an idiopathic form caused by age-related changes of the vitreous body and a secondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays a major role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or a reduction of metamorphopsia can be achieved, with a number of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.
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Affiliation(s)
- Jakob Holzwarth
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland
| | - Tim U Krohne
- Augenzentrum, St. Franziskus Hospital, Münster, Deutschland
| | - Albrecht Lommatzsch
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | | | - Lars-Olof Hattenbach
- Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland.
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Choi J, Kim SJ, Kang SW, Hwang S, Son KY. Outcomes of epiretinal proliferation embedding technique in the surgery for full-thickness macular hole. Sci Rep 2024; 14:8170. [PMID: 38589441 PMCID: PMC11001908 DOI: 10.1038/s41598-024-58449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Young Son
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea
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SPONTANEOUS REATTACHMENT OF RHEGMATOGENOUS RETINAL DETACHMENT: Observations of the Vitreoretinal Interface. Retina 2023; 43:321-329. [PMID: 36695801 DOI: 10.1097/iae.0000000000003650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To describe the clinical characteristics and posterior vitreous findings of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD). METHODS Eighty-six eyes from 80 patients who were diagnosed with SRRRD (SRRRD group) and 92 eyes from 92 patients who had undergone successful scleral buckling for rhegmatogenous retinal detachment ( group for comparison) were included. Ultrawide field fundus imaging and spectral domain optical coherence tomography were performed to evaluate fundus characteristics and vitreoretinal interface. RESULTS A significant difference was found in the proportion of complete posterior vitreous attachment between the SRRRD and rhegmatogenous retinal detachment groups (44.2% vs. 19.6%, P < 0.001). The incidence of atypical epiretinal tissue (AET) in the SRRRD group was 14% (12 of 86 eyes), whereas none of the eyes in the rhegmatogenous retinal detachment group exhibited AET. In SRRRD eyes with AET, the visual acuity was lower (logarithm of the minimum angle of resolution, 0.51 ± 0.57 vs. 0.14 ± 0.15, P < 0.001), the mean age was higher (years, 61.7 vs. 39.4, P < 0.001), and the SRRRD lesion extent was wider (clock hours, 5.67 vs. 3.70, P = 0.004) than in SRRRD eyes without AET. CONCLUSION Compared with the rhegmatogenous retinal detachment group, the SRRRD group had a higher incidence of posterior vitreous attachment. Furthermore, AET was a significant comorbidity in the eyes with SRRRD, particularly in the elderly and the area of presumed reattachment over two quadrants and was related to worse functional outcomes.
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Nakamura K, Inoue T, Nagura K, Tanaka Y, Arasaki R, Asaoka R, Yanagi Y, Maruyama-Inoue M, Kadonosono K. Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole. Eye (Lond) 2022; 36:2247-2252. [PMID: 34799707 PMCID: PMC9674578 DOI: 10.1038/s41433-021-01818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions. METHOD In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated. RESULTS Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE. CONCLUSION Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.
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Affiliation(s)
- Kentaro Nakamura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan.
| | - Koichi Nagura
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Yui Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Rei Arasaki
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- Seirei Christopher University, Shizuoka, Japan
| | - Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Kanagawa, Japan
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9
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Jones CH, Gui W, Schumann RG, Boneva S, Lange CAK, van Overdam K, Chui TYP, Rosen RB, Engelbert M, Sebag J. Hyalocytes in proliferative vitreo-retinal diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:263-280. [PMID: 36466118 PMCID: PMC9718005 DOI: 10.1080/17469899.2022.2100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
Abstract
Introduction Hyalocytes are sentinel macrophages residing within the posterior vitreous cortex anterior to the retinal inner limiting membrane (ILM). Following anomalous PVD and vitreoschisis, hyalocytes contribute to paucicellular (vitreo-macular traction syndrome, macular holes) and hypercellular (macular pucker, proliferative vitreo-retinopathy, proliferative diabetic vitreo-retinopathy) diseases. Areas covered Studies of human tissues employing dark-field, phase, and electron microscopy; immunohistochemistry; and in vivo imaging of human hyalocytes. Expert opinion Hyalocytes are important in early pathophysiology, stimulating cell migration and proliferation, as well as subsequent membrane contraction and vitreo-retinal traction. Targeting hyalocytes early could mitigate advanced disease. Ultimately, eliminating the role of vitreous and hyalocytes may prevent proliferative vitreo-retinal diseases entirely.
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Affiliation(s)
| | - Wei Gui
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | | | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens AK Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | | | - Toco YP Chui
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York; NYU School of Medicine, New York, USA
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
- Doheny Eye Institute, UCLA, Pasadena, California, USA
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10
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Hwang S, Kang SW. The clinical and pathogenic significance of atypical epiretinal tissue in macular hole. Graefes Arch Clin Exp Ophthalmol 2022; 260:2791-2798. [PMID: 35838804 DOI: 10.1007/s00417-022-05750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023] Open
Abstract
With the recent advent of high-resolution optical coherence tomography (OCT), atypical epiretinal tissue (AET), also known as epiretinal proliferation, has been frequently noted in various pathologies. AET presents as premacular tissue with homogenous medium reflectivity over the internal limiting membrane on OCT. Although AET is most frequently associated with a lamellar hole (LH), some cases of macular hole (MH) also accompany AET at the edge of the hole. MH with AET has been reported to have worse clinical and surgical outcomes than MH without AET. The imaging and histopathological findings of AET imply that the development of MH with AET may not have been driven by vitreofoveal traction. Instead, MH with AET might have evolved from LH with AET. This mini-review encompassed relevant studies on MH with AET published to date and explained the clinical, prognostic, and pathogenic significance of AET in MH in detail.
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Affiliation(s)
- Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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11
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Hagenau F, Luft N, Nobl M, Vogt D, Klaas JE, Schworm B, Siedlecki J, Kreutzer TC, Priglinger SG. Improving morphological outcome in lamellar macular hole surgery by using highly concentrated autologous platelet-rich plasma. Graefes Arch Clin Exp Ophthalmol 2021; 260:1517-1524. [PMID: 34870734 PMCID: PMC9007791 DOI: 10.1007/s00417-021-05486-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To evaluate the use of highly concentrated autologous platelet-rich plasma (PRP) in lamellar macular hole (LMH) surgery with regard to function and morphology. Methods We included 12 eyes of 12 patients with progressive LMH in this interventional case series. After 23/25-gauge pars plana vitrectomy, 0.1ml highly concentrated autologous platelet-rich plasma was applied under air tamponade. Induction of posterior vitreous detachment and peeling of tractive epiretinal membranes were performed whenever present. Phacovitrectomy was undertaken in cases of phakic lens status. Postoperatively, all patients were instructed to rest in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT), and fundus photography were carried out preoperatively and 6 months postoperatively. Results Foveal configuration was restored in 10 of 12 patients (83.3%) at 6 months postoperatively. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (Wilcoxon: p=0.028). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p=0.67). No patient experienced vision loss after surgery, and no significant intra- or postoperative complications occurred. Conclusion The application of PRP in the surgical therapy of LMH results in good morphological and functional outcomes. Additional peeling of the ILM seems to be mandatory when using PRP to prevent the recurrence of LMH. Strict postoperative supine positioning for 2 h avoids PRP dislocation. Larger sample sizes are needed to confirm the results.
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Affiliation(s)
- Felix Hagenau
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Nikolaus Luft
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Matthias Nobl
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Denise Vogt
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Julian E Klaas
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Benedikt Schworm
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Jakob Siedlecki
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Thomas C Kreutzer
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany
| | - Siegfried G Priglinger
- University Eye Hospital, Ludwig-Maximilians-University, Mathildenstrasse 8, 80336, Munich, Germany.
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12
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Epiretinal proliferation after rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2021; 260:1509-1516. [PMID: 34821991 DOI: 10.1007/s00417-021-05502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine the characteristics and appearance rate of epiretinal proliferation (ERP) on SD-OCT after surgery for rhegmatogenous retinal detachment (RRD) repair. METHODS One hundred eight eyes of 108 patients who underwent one or more surgeries for RRD were enrolled. The eyes with other maculopathies that were directly related to RRD were excluded. Image acquisition was performed with SD-OCT (Heidelberg Engineering, Germany). Clinical charts were reviewed to assess clinical and surgical findings. Statistical analyses were performed using XLSTAT (Assinsoft, Paris, France). RESULTS ERP was found in 9.3% eyes (n = 10). The mean initial visual acuity (logMAR) was 1.34 ± 0.82 in the ERP group compared to 0.49 ± 0.70 in the non-ERP group. PVR was present in 70.0% and chronic macular edema was found in 80.0% of eyes which developed ERP. The mean number of vitreoretinal surgeries in eyes with ERP was 3.3 ± 1.19 and only 1.44 ± 1.02 in eyes without. Silicone oil was used in 60.0% of eyes which developed ERP compared to 13.9% in the non-ERP group. CONCLUSION ERP is a late-onset postoperative finding in eyes with RRD and can occur in absence of macular holes. Overall, ERP is more frequent in eyes with complicated courses of RRD including multiple operations, PVR, usage of silicone oil, and chronic macular edema.
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13
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Bringmann A, Unterlauft JD, Barth T, Wiedemann R, Rehak M, Wiedemann P. Müller cells and astrocytes in tractional macular disorders. Prog Retin Eye Res 2021; 86:100977. [PMID: 34102317 DOI: 10.1016/j.preteyeres.2021.100977] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Tractional deformations of the fovea mainly arise from an anomalous posterior vitreous detachment and contraction of epiretinal membranes, and also occur in eyes with cystoid macular edema or high myopia. Traction to the fovea may cause partial- and full-thickness macular defects. Partial-thickness defects are foveal pseudocysts, macular pseudoholes, and tractional, degenerative, and outer lamellar holes. The morphology of the foveal defects can be partly explained by the shape of Müller cells and the location of tissue layer interfaces of low mechanical stability. Because Müller cells and astrocytes provide the structural scaffold of the fovea, they are active players in mediating tractional alterations of the fovea, in protecting the fovea from such alterations, and in the regeneration of the foveal structure. Tractional and degenerative lamellar holes are characterized by a disruption of the Müller cell cone in the foveola. After detachment or disruption of the cone, Müller cells of the foveal walls support the structural stability of the foveal center. After tractional elevation of the inner layers of the foveal walls, possibly resulting in foveoschisis, Müller cells transmit tractional forces from the inner to the outer retina leading to central photoreceptor layer defects and a detachment of the neuroretina from the retinal pigment epithelium. This mechanism plays a role in the widening of outer lameller and full-thickness macular holes, and contributes to visual impairment in eyes with macular disorders caused by conractile epiretinal membranes. Müller cells of the foveal walls may seal holes in the outer fovea and mediate the regeneration of the fovea after closure of full-thickness holes. The latter is mediated by the formation of temporary glial scars whereas persistent glial scars impede regular foveal regeneration. Further research is required to improve our understanding of the roles of glial cells in the pathogenesis and healing of tractional macular disorders.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany.
| | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
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14
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Hagenau F, Nobl M, Vogt D, Schworm B, Siedlecki J, Kreutzer T, Luft N, Priglinger S. Highly Concentrated Autologous Platelet-Rich Plasma Restores Foveal Anatomy in Lamellar Macular Hole Surgery. Klin Monbl Augenheilkd 2021; 238:885-892. [PMID: 34000748 DOI: 10.1055/a-1409-9268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lamellar macular holes (LMHs) are an entity of a progressive disease in which the efficacy of the therapy of choice, vitrectomy, seems to be reduced. It is unknown whether highly concentrated autologous platelet-rich plasma (PRP) is of value in the therapy of LMHs. The purpose of this study was to gauge the potential of highly concentrated PRP to restore foveal anatomy in LMH surgery. PATIENTS AND METHODS In this interventional case series, eight eyes of eight patients with progressive LMH were included. All patients underwent a 23-gauge pars plana vitrectomy with induction of a posterior vitreous detachment and peeling of tractive epiretinal membranes whenever present. Under air tamponade, 0.1 mL of highly concentrated autologous PRP was applied. Subsequently, a gas or air tamponade was performed. All patients were instructed to rest in the supine position for the first 1 to 2 postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT) and fundus photography were performed prior to and 3 months after surgery. RESULTS SD-OCT showed closure of the macular defect with restoration of a normal foveal configuration in all (8 of 8) patients 3 months postoperatively. BCVA improved significantly, from 0.28 ± 0.08 to 0.12 ± 0.14 logMAR (Wilcoxon: p = 0.03). Microperimetry remained unchanged (24.13 ± 1.96 vs. 23.7 ± 1.54 dB; p = 0.46). No clinically significant intra- or postoperative complications were observed. CONCLUSION The use of highly concentrated PRP enables excellent anatomical and functional outcomes in the surgical therapy of LMH. Further prospective comparative trials are warranted to compare this promising technique with existing surgical strategies.
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Affiliation(s)
- Felix Hagenau
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Matthias Nobl
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Denise Vogt
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Benedikt Schworm
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Kreutzer
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig Maximilians University of Munich, Munich, Germany
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15
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[Statement of the Professional Association of German Ophthalmologists (BVA), the German Ophthalmological Society (DOG) and the Retinological Society (RG) on the development, diagnostics and treatment of epiretinal gliosis : Status October 2020]. Ophthalmologe 2021; 118:121-138. [PMID: 33346894 DOI: 10.1007/s00347-020-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Abstract
Advances in imaging techniques of the retina have substantially enhanced our current understanding of the pathogenesis, morphology and prognosis of vitreomacular retinal diseases. Optical coherence tomography-based criteria and classification systems were recently proposed for uniform diagnoses and treatment recommendations for patients with vitreomacular traction, epiretinal gliosis and the various forms of macular holes. This article provides an overview of the different retinal imaging modalities as well as the currently recommended classification for vitreomacular traction pathologies.
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17
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Chehaibou I, Pettenkofer M, Govetto A, Rabina G, Sadda SR, Hubschman JP. Identification of epiretinal proliferation in various retinal diseases and vitreoretinal interface disorders. Int J Retina Vitreous 2020; 6:31. [PMID: 32670614 PMCID: PMC7350739 DOI: 10.1186/s40942-020-00233-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background To describe the presence of epiretinal proliferation in eyes with various retinal and vitreoretinal interface conditions. Methods Consecutive patients seen at the Stein Eye Institute, by one retina specialist, from December 2018 to March 2019, and demonstrating epiretinal proliferation on optical coherence tomography (OCT) were enrolled in this cross-sectional study. Included patients were divided into two groups: vitreoretinal interface pathologies group or retinal diseases group. Presence of epiretinal proliferation and its localization within the 9 macular sectors, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS), were assessed on OCT. Results 77 eyes from 69 patients demonstrated epiretinal proliferation on OCT. The most frequently involved ETDRS sector was the 1-mm central subfield, followed by inner temporal and inner nasal sectors. Localization of epiretinal proliferation correlated with the presence of any retinal abnormalities in the same quadrant (r = 0.962; P < 0.0001). 31 eyes (40.3%) demonstrated symptomatic vitreoretinal interface pathologies including lamellar macular hole, full-thickness macular hole, epiretinal membrane and history of macular peeling. 46 eyes (59.7%) manifested various retinal diseases, including age-related macular degeneration, diabetic retinopathy, refractory macular edema, vein occlusion and high myopia. Conclusions Epiretinal proliferation was noted in several retinal conditions and not limited only to full-thickness and lamellar macular holes. Different mechanisms affecting retinal homeostasis might trigger Müller cells dysregulation, potentially leading to abnormal retinal remodeling.
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Affiliation(s)
- Ismael Chehaibou
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 USA.,Ophthalmology Department, AP-HP, Université de Paris, Hôpital Lariboisière, 75010 Paris, France
| | - Moritz Pettenkofer
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 USA
| | - Andrea Govetto
- Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Gilad Rabina
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 USA.,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA USA
| | - Jean-Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 USA
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18
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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 2020. [DOI: 10.1007/s00417-020-04735-3 10.1007/s00417-020-04735-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 2020; 258:2151-2161. [PMID: 32583283 DOI: 10.1007/s00417-020-04735-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. METHODS Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. RESULTS The mean duration of the MH prior to SR-fluid application was 17 months (6-96 months). The mean age of the patients at the time of surgery was 72 years (54-88). The mean preoperative aperture diameter of the opening was 1212 μm (239-4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01-0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02-0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. CONCLUSION Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.
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20
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Sebag J. Vitreous and Vision Degrading Myodesopsia. Prog Retin Eye Res 2020; 79:100847. [PMID: 32151758 DOI: 10.1016/j.preteyeres.2020.100847] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022]
Abstract
Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuous, the vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.
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Affiliation(s)
- J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA; Doheny Eye Institute, Pasadena, CA, USA; Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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21
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Vogt D, Wachtlin J, Priglinger SG, Schumann RG. [Lamellar macular holes : Morphological characteristics and treatment success]. Ophthalmologe 2019; 116:1020-1025. [PMID: 31531706 DOI: 10.1007/s00347-019-00966-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice. OBJECTIVE This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies. MATERIAL AND METHODS The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany. RESULTS In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated. CONCLUSION Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.
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Affiliation(s)
- Denise Vogt
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland.
| | - Joachim Wachtlin
- Augenabteilung, Sankt Gertrauden Krankenhaus, Berlin, Deutschland.,MHB, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Siegfried G Priglinger
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
| | - Ricarda G Schumann
- Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland
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