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Dinice L, Esposito G, Cacciamani A, Balzamino BO, Cosimi P, Cafiero C, Ripandelli G, Micera A. TLR2 and TLR4 Are Expressed in Epiretinal Membranes: Possible Links with Vitreous Levels of Complement Fragments and DAMP-Related Proteins. Int J Mol Sci 2024; 25:7732. [PMID: 39062973 PMCID: PMC11276880 DOI: 10.3390/ijms25147732] [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: 05/24/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Previous studies reported the expression of toll-like receptors (TLRs), merely TLR2 and TLR4, and complement fragments (C3a, C5b9) in vitreoretinal disorders. Other than pathogens, TLRs can recognize endogenous products of tissue remodeling as damage-associated molecular pattern (DAMPs). The aim of this study was to confirm the expression of TLR2 and TLR4 in the fibrocellular membranes and vitreal fluids (soluble TLRs) of patients suffering of epiretinal membranes (ERMs) and assess their association with disease severity, complement fragments and inflammatory profiles. Twenty (n = 20) ERMs and twelve (n = 12) vitreous samples were collected at the time of the vitrectomy. Different severity-staged ERMs were processed for: immunolocalization (IF), transcriptomic (RT-PCR) and proteomics (ELISA, IP/WB, Protein Chip Array) analysis. The investigation of targets included TLR2, TLR4, C3a, C5b9, a few selected inflammatory biomarkers (Eotaxin-2, Rantes, Vascular Endothelial Growth Factor (VEGFA), Vascular Endothelial Growth Factor receptor (VEGFR2), Interferon-γ (IFNγ), Interleukin (IL1β, IL12p40/p70)) and a restricted panel of matrix enzymes (Matrix metalloproteinases (MMPs)/Tissue Inhibitor of Metallo-Proteinases (TIMPs)). A reduced cellularity was observed as function of ERM severity. TLR2, TLR4 and myD88 transcripts/proteins were detected in membranes and decreased upon disease severity. The levels of soluble TLR2 and TLR4, as well as C3a, C5b9, Eotaxin-2, Rantes, VEGFA, VEGFR2, IFNγ, IL1β, IL12p40/p70, MMP7 and TIMP2 levels were changed in vitreal samples. Significant correlations were observed between TLRs and complement fragments and between TLRs and some inflammatory mediators. Our findings pointed at TLR2 and TLR4 over-expression at early stages of ERM formation, suggesting the participation of the local immune response in the severity of disease. These activations at the early-stage of ERM formation suggest a potential persistence of innate immune response in the early phases of fibrocellular membrane formation.
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Affiliation(s)
- Lucia Dinice
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.D.); (G.E.); (B.O.B.)
| | - Graziana Esposito
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.D.); (G.E.); (B.O.B.)
| | - Andrea Cacciamani
- Surgical Retina Research Unit, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Bijorn Omar Balzamino
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.D.); (G.E.); (B.O.B.)
| | - Pamela Cosimi
- Surgical Retina Research Unit, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Concetta Cafiero
- Anatomic Pathology Unit, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy;
| | - Guido Ripandelli
- Surgical Retina Research Unit, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (A.C.); (P.C.); (G.R.)
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Science, IRCCS—Fondazione Bietti, 00184 Rome, Italy; (L.D.); (G.E.); (B.O.B.)
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Naftali S, Della Rocca K, Gershoni A, Ehrlich R, Ratnovsky A. Mechanical impact of epiretinal membranes on the retina utilizing finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108020. [PMID: 38237448 DOI: 10.1016/j.cmpb.2024.108020] [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: 08/15/2023] [Revised: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Epiretinal membrane (ERM) is a transparent membrane that forms on the surface of the neurosensory retina, causing tangential traction on the retinal surface, which may contribute to cell proliferation and contraction. Epiretinal membranes (ERMs) may be asymptomatic in some patients, while in others the membranes can progress, resulting in macular thickening and macular traction, thus distorting and inducing loss of central visual function and metamorphopsia. Currently, treatment options include follow-up or pars plana vitrectomy with an ERM peel, aiming to relieve the macular traction and improve vision and metamorphopsia. No specific criteria exist for predicting which patients might progress and need early surgery to improve and maintain good vision. The decision for surgery is based on the individual's symptoms and the physician's judgment. This study aimed to evaluate the mechanical impact in terms of stress and deformations of the ERM and to qualitatively compare them with the clinical progression of fovea thickening observed through optical coherence tomography (OCT) images. METHODS Numerical simulation on a three-dimensional geometrical retina and ERM model was applied to isolate factors that can be used to predict its progression and prognosis. OCT images of 14 patients with ERM were used to derive the fovea thickness progression before and after vitrectomy surgery with ERM peeling. RESULTS The results clearly show that the increase in ERM contractility level increases the developed stress at the fovea, which spreads and advances toward its base. The highest stress level (2.1 kPa) was developed at the highest and asymmetric contractility, producing non-uniform distributed deformations that distort the fovea structure. CONCLUSIONS These findings imply that high and asymmetric ERM contractility should be evaluated clinically as a factor that might signal the need for early vitrectomy surgery to avoid irreversible visual loss. Moreover, the OCT images revealed that in some cases, the thickness of the fovea indeed remains high, even after ∼12 months postoperatively, which also indicates that the deformation of the fovea in these cases is irreversible.
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Affiliation(s)
- Sara Naftali
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel.
| | - Keren Della Rocca
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel
| | - Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Rita Ehrlich
- Ophthalmology Division, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Anat Ratnovsky
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel
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Zhang B, Dong X, Sun Y. Effect of internal limiting membrane peeling for idiopathic epiretinal membrane. Heliyon 2023; 9:e14079. [PMID: 36915505 PMCID: PMC10006490 DOI: 10.1016/j.heliyon.2023.e14079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To further evaluate the necessity of internal limiting membrane (ILM) peeling for patients with idiopathic epiretinal membrane (iERM). Method We searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI from their inception up to August 24, 2021. Eligible meta-analyses comparing iERM removal with and without ILM peeling were included. AMSTAR and GRADE classification was used to assess the methodological quality of each study and the quality for each outcome, respectively. The primary outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), and recurrence. Results 10 meta-analyses were included. 75.9% of studies revealed no statistically significant difference in BCVA between the groups, while only 10.3% showed better BCVA favorable to additional ILM peeling. 54.2% reported no significant difference in CMT between the groups, followed by 41.7% showing thicker CMT due to additional ILM peeling. Compared to iERM removal alone, additional ILM peeling provided a lower recurrence rate in 66.7% of studies. Conclusion ILM peeling could significantly reduce recurrence rate, but not significantly improve the recovery of visual outcome or decrease the thickness of central macula.
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Affiliation(s)
- Bowen Zhang
- Surgical Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xingmei Dong
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Yi Sun
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Structure-function association between contrast sensitivity and retinal thickness (total, regional, and individual retinal layer) in patients with idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2023; 261:631-639. [PMID: 36149494 DOI: 10.1007/s00417-022-05819-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate structure-function associations between retinal thickness, visual acuity (VA), and contrast sensitivity (CS), using the quantitative contrast sensitivity function (qCSF) method in patients with idiopathic epiretinal membrane (ERM). METHODS Retrospective, cross-sectional observational study. Patients with a diagnosis of idiopathic ERM were included. Patients underwent complete ophthalmic examination, spectral-domain optical coherence tomography imaging (SD-OCT) (SPECTRALIS® Heidelberg), and CS testing using the qCSF method. Outcomes included area under the log CSF (AULCSF), contrast acuity (CA), and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). RESULTS A total of 102 eyes of 79 patients were included. Comparing standardized regression coefficients, retinal thickness in most ETDRS sectors was associated with larger reductions in AULCSF, CA, and CS thresholds at 3 and 6 cpd than those in logMAR VA. These differences in effect on VA and CS metrics were more pronounced in the central subfield and inner ETDRS sectors. Among the retinal layers, increased INL thickness had the most detrimental effect on visual function, being significantly associated with reductions in logMAR VA, AULCSF, CA, and CS thresholds at 3 and 6 cpd (all p < .01), as well as at 1.5 and 12 cpd (p < .05). CONCLUSION Retinal thickness seems to be associated with larger reductions in contrast sensitivity than VA in patients with ERM. Measured with the qCSF method, contrast sensitivity may serve as a valuable adjunct visual function metric for patients with ERM.
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Nakakura S, Asaoka R, Oogi S, Aoki R, Terao E, Ueda K, Kiuchi Y. Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma. Front Med (Lausanne) 2022; 9:972962. [PMID: 36388915 PMCID: PMC9644160 DOI: 10.3389/fmed.2022.972962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background/objectivesCo-existing idiopathic epiretinal membrane (ERM) and glaucoma complicate the estimation of glaucoma severity via optical coherence tomography (OCT). We investigated the effect of ERM and a new associated parameter, SUKIMA (space between the ERM and retinal surface), on ganglion cell complex (GCC) thickness in eyes with glaucoma, based on a matched comparison of visual field defects.Subjects/methodsWe retrospectively recruited 41 eyes from 34 glaucoma patients with idiopathic ERM and 41 eyes from 41 glaucoma patients without ERM as controls (matched by age, axial length, and mean visual field deviation). The thicknesses of GCC layers [retinal nerve fiber layer (RNFL), ganglion cell layer + inner plexiform layer (GCIPL), and GCC (RNFL + GCIPL)] were measured with swept-source OCT. We investigated the presence of SUKIMA and its effect on GCC measurements.ResultsRNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control eyes (31.0 ± 12.3 μm vs. 22.7 ± 10.8 μm, 62.6 ± 12.2 μm vs. 53.8 ± 5.9 μm, and 91.8 ± 16.6 μm vs. 76.8 ± 13.3 μm, respectively; P < 0.01). Eyes in the ERM-associated SUKIMA (+) group had thicker GCIPL and GCC than those in the ERM-associated SUKIMA (−) and control groups (P < 0.01).ConclusionERM-associated SUKIMA affects GCC thickness and can result in underestimations of glaucoma severity. We should check for the presence of ERM using a B mode scan as well as check for the SKIMA sign.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
- *Correspondence: Shunsuke Nakakura,
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Department of Nursing, Seirei Christopher University, Hamamatsu, Japan
- Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Japan
- Ryo Asaoka,
| | - Satomi Oogi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Ryota Aoki
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Etsuko Terao
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Kanae Ueda
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Clinical features and prognosis in idiopathic epiretinal membranes with different types of intraretinal cystoid spaces. Retina 2022; 42:1874-1882. [DOI: 10.1097/iae.0000000000003537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effects of Ectopic Inner Foveal Layers on Foveal Configuration and Visual Function after idiopathic Epiretinal Membrane Surgery. Retina 2022; 42:1472-1478. [PMID: 35502976 DOI: 10.1097/iae.0000000000003495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effects of ectopic inner foveal layers (EIFLs) on foveal configuration recovery and visual acuity (VA) after idiopathic epiretinal membrane (iERM) removal and analyze the relationship of foveal configuration recovery between 1-month and long-term postoperatively. METHODS This retrospective study included 216 consecutive eyes with iERM that underwent vitrectomy surgery. A comprehensive ophthalmic examination was performed for all patients before and 1, 4,10, and 24 months after surgery. We observed the postoperative anatomical and functional recovery of eyes with and without EIFLs and analyzed the association between short-term and long-term anatomical recovery. RESULTS The presence of EIFL was associated with severe preoperative visual damage (P<0.001) and was considered as a negative factor for postoperative foveal depression recovery (P<0.001). No significant difference was found in postoperative BCVA between the eyes with and without EIFLs (P=0.442). For eyes with stage II ERMs, 17.6% developed EIFLs postoperatively, which did not affect the final BCVA. Overall, 24.5% of ERMs restored the foveal configurations at 1 month postoperatively, and 14.7% continued recovering during the follow-up. Foveal structure recovery in eyes with EIFLs was associated with earlier stage, fewer microcystic macular edema, complete IZ layer, and a thinner CFT (All P<0.05) at 1-month postoperatively. CONCLUSIONS The EIFL is associated with severe preoperative visual damage and is a negative factor for postoperative anatomical recovery, but it is a minor factor for postoperative VA. We also found an association of foveal configuration recovery between 1-month and long-term after surgery.
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