J Korean Ophthalmol Soc.  2008 Jun;49(6):917-924. 10.3341/jkos.2008.49.6.917.

The Structure of the Internal Limiting Membrane Removed by Vitrectomy Using Tissue Plasminogen Activator

• Kim DS
• Moon SW
• Yu SY
• Kwak HW

• KMID: 2110872
• DOI: http://doi.org/10.3341/jkos.2008.49.6.917

Abstract

PURPOSE: This study evaluated the effect of tissue plasminogen activator (TPA) on adhesion between the internal limiting membrane and the vitreous cortex in patients with diabetic macular edema.
METHODS
This retrospective study included 14 eyes of 14 patients with diabetic macular edema without posterior vitreous detachment. The fourteen eyes were divided into two groups. In the first group, vitrectomy and internal limiting membrane (ILM) removal were performed after intravitreal TPA 0.1 cc (50 ug) injection the day before vitrectomy and in the second group, vitrectomy and ILM removal were performed without previous injection of TPA. We observed the ILM using electron microscopy and verified the effects of the TPA.
RESULTS
Spontaneous posterior vitreous detachment occurred in 3 of 7 eyes in the first group. Internal limiting membranes removed by vitrectomy showed a smooth surface in 4 of 7 eyes in the first group and in 1 of 7 eyes in the second group. Seven eyes of the first group and 6 eyes of the second group revealed decreased foveal thickness and increased visual acuity 90 days postoperatively.
CONCLUSIONS
Preoperative intravitreal TPA injection was helpful for achieving posterior vitreous detachment and for decreasing possible postoperative complications involving in remnant vitreous cortex in patients with diabetic macular edema.

Keyword

Diabetic macular edema; Internal limiting membrane; Tissue plasminogen activator

MeSH Terms

Eye
Humans
Macular Edema
Membranes
Microscopy, Electron
Postoperative Complications
Retrospective Studies
Tissue Plasminogen Activator
Visual Acuity
Vitrectomy
Vitreous Detachment
Tissue Plasminogen Activator

Figure

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  Figure 1. Transmission electron microscopy showing no collagen fiber (A) and collagen fibers (B) on the vitreal surface of the internal limiting membrane.

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  Figure 2. Scanning electron microscopy showing vitreal surfaces of the internal limiting membrane (ILM). Collagen fibers were not detected in the first group (A) but detected in the second group (B).

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  Figure 3. Transmission electron microscopy showing the retinal surface of the internal limiting membrane (ILM). Cytoplasm and plasma membrane of the Muller cells were seen on the retinal surface of the ILM (A) and scanning electron microscopy showing some retinal debris covering retinal surfaces of the ILM (B).

Reference

References

1. Akiba J, Arzabe CW, Trempe CL. Posterior vitreous detachment and neovascularization in diabetic retinopathy. Ophthalmology. 1990; 97:889–91.

2. Hikichi T, Yoshida A, Trempe CL. Effect of the vitreous on the prognosis of full thickness idiopathic macular hole. Am J Ophthalmol. 1993; 116:273–8.

3. Hikichi T, Yoshida A, Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol. 1995; 119:55–61.

4. Takahashi MK, Hikichi T, Akiba J. . Role of the vitreous and macular edema in branch retinal vein occlusion. Ophthalmic Surg Lasers. 1997; 28:294–9.

5. Hayreh SS, Jonas JB. Posterior Vitreous detachment : Clinical correlations. Ophthalmologica. 2004; 218:333–43.

6. Sebag J. Diabetic vitreopathy. Ophthalmology. 1996; 103:205–6.

7. Sonoda K, Sakamoto T, Enaida H. . Residual vitreous cortex after surgical posterior vitreous separation visualized by intravitreal triamcinolone acetonide. Ophthalmology. 2004; 111:226–30.

8. Kim NJ, Yu HG, Yu YS. . Long‐ term Effect of plasmin on the vitreolysis in rabit eyes. Korean J Ophthalmol. 2004; 18:35–40.

9. Sebag J. Pharmacologic vitreolysis. Retina. 1998; 18:1–3.

10. Sebag J. Pharmacologic vitreolysis brewing? Retina. 2002; 22:1–5.

11. Asami T, Terasaki H, Kachi S. . Ultrastructure of internal limiting membrane removed during plasmin assisted vitrectomy from eyes with diabetic macular edema. Ophthalmology. 2004; 111:231–7.

12. Kuppermann BD, Thomas EL, de Smet MD. . Safety results of two phase Ⅲ trials of an intravitreous injection of highly purified ovine hyaluronidase (Vitrease) for the management of vitreous hemorrhage. Am J Ophthalmol. 2005; 140:585–97.

13. Verstraeten TC, Chapman C, Hartzer M. . Pharmacologic induction of posterior vitreous detachment in the rabbit. Arch Ophthalmol. 1993; 111:849–54.

14. Gandorfer A, Putz E. . Ultrastructure of the vitreoretinal interface following plasmin assisted vitrectomy. Br J Ophthalmol. 2001; 85:6–10.

15. Gandorfer A, Priglinger S, Schebitz K. . Vitreretinal morphology of plasmin‐ treated human eyes. Am J Ophthalmol. 2002; 133:156–9.

16. Gandorfer A, Haritoglou C, Kampik A. Ultrastructure of the internal limiting membrane (ILM) in diabetic eyes in a recent issue of Retina. Retina. 2006; 26:122–3.

17. Hesse L, Kroll P. TPA‐ assisted vitrectomy for proliferative diabetic retinopathy. Retina. 2000; 20:317–8.

18. Le Mer Y, Korobelnik JF, Morel C. . TPA‐ assisted vitrectomy for proliferative diabetic retinopathy: results of a double‐ masked, multicenter trial. Retina. 1999; 19:378–82.

19. Lewis H. The role of vitrectomy in the treatment of diabetic macular edema. Am J Ophthalmol. 2001; 131:123–5.

20. Harbour JW, Smiddy WE, Flynn HW Jr, Rubsamen PE. Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 1996; 121:405–13.

21. Kaiser PK, Reimann CD, Lewis H. . Macular traction detachment and diabetic macular edema associated with posterior hyaloid traction. Am J Ophthalmol. 2001; 131:44–9.

22. Yamamoto T, Akabane N, Takeuchi S. Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol. 2001; 132:369–77.

23. Sebag J, Buckingham B, Charles MA. . Biochemical abnormalities in vitreous of human with proliferative diabetic retinopathy. Arch Ophthalmol. 1992; 110:1472–6.

24. Stefansson E. The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology. Acta Ophthalmol Scand. 2001; 79:435–40.

25. Patel JI, Hykin PG, Schadt M. . Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina. 2006; 26:5–13.

26. Gandorfer A, Rohleder M, Grosselfinger S. . Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction. Am J Ophthalmol. 2005; 139:638–52.

27. Gandorfer A, Haritoglou C, Gandorfer A, Kampik A. Retinal damage from indocyanine green in experimental macular surgery. Invest Ophthalmol Vis Sci. 2003; 44:316–23.

28. Nakamura T, Murata T, Hisatomi T. . Ultrastructure of the vitreoretinal interface following the removal of the internal limiting membrane using indocyanine green. Curr Eye Res. 2003; 27:395–9.