Korean J Ophthalmol.  2019 Apr;33(2):142-149. 10.3341/kjo.2018.0070.

Epiretinal Proliferation Associated with Lamellar Hole or Macular Hole: Origin and Surgical Prognosis

Affiliations
  • 1Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea. jhsohn19@hanafos.com
  • 2Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
  • 3Department of Ophthalmology, Asan Medical Center, Seoul, Korea.

Abstract

PURPOSE
To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after vitrectomy.
METHODS
This is a retrospective observational case review of 17 eyes with EP that underwent vitrectomy, EP dissection, and internal limiting membrane peeling between January 2013 and December 2016. Surgical specimens of EP tissue were successfully obtained from 5 cases and they were analyzed after immunohistochemical staining. Postoperative outcomes, including best-corrected visual acuity (BCVA) and macular configuration in spectral domain-optical coherence tomography, were reviewed.
RESULTS
Mean BCVA improved from 0.54 ± 0.36 logarithms of the minimum angle of resolution preoperatively to 0.32 ± 0.38 logarithms of the minimum angle of resolution postoperatively (p = 0.002). BCVA improved in 13 eyes and remained unchanged in four eyes. No cases experienced vision decline after surgery. All 17 patients' lamellar hole or macular hole were successfully closed. Despite hole closure, ellipsoid zone defects were not corrected in 11 of the 17 patients. In immunohistochemical analyses, anti-glial fibrillary acidic protein and pan-keratin (AE1/AE3) were positive, but synaptophysin, anti-α-smooth muscle actin, and anti-CD68 were negative.
CONCLUSIONS
The epiretinal proliferative membrane seems to originate from Müller cells, not from the vitreous. It is unclear whether retinal pigment epithelia also contribute to EP formation. Gentle handling and preservation of the epiretinal proliferative tissue is crucial for successful surgical outcomes.

Keyword

Epiretinal proliferation; Lamellar hole; Macular hole; Müller cells

MeSH Terms

Actins
Humans
Membranes
Prognosis*
Retinal Perforations*
Retinaldehyde
Retrospective Studies
Synaptophysin
Visual Acuity
Vitrectomy
Actins
Retinaldehyde
Synaptophysin

Figure

  • Fig. 1 Logarithm of the minimum angle of resolution (logMAR) visual results after in patient with epiretinal proliferation associated with lamellar hole or macular hole.

  • Fig. 2 (A,B) Preoperative and postoperative optical coherence tomographic (OCT) images of lamellar hole (patient 15), (C,D) full-thickness macular hole (FTMH) (patient 14), and (E,F) impending macular hole (I-MH) (patient 10) with epiretinal proliferation (EP). (A) Preoperative OCT scan shows lamellar hole with EP (arrows) and ellipsoidal zone defect (arrowhead). (B) Postoperative OCT scan (6 months after surgery) shows closed lamellar hole and ellipsoidal zone defect restored. (C) Preoperative OCT scan shows FTMH with EP (arrows). (D) Postoperative OCT scan (3 months after surgery) shows closed FTMH and ellipsoidal zone defect (arrowhead) remained. (E) Preoperative OCT scan shows I-MH with EP (arrows) and ellipsoidal zone defect (arrowhead). (F) Postoperative OCT scan (3 months after surgery) shows closed I-MH and ellipsoidal zone defect restored.

  • Fig. 3 Histopathological analysis of epiertinal proliferation tissue. (A,B) Hematoxylin and eosin staining of epiretinal proliferative tissue (×400). Aggregation of lymphocytes and cells with medium-density nucleus are scattered. There were no hyalocytes and fibroblasts identified. (C,D) Pan-keratin staining of epiretinal proliferative tissue (×100). Note cells with brownish-stained cytoplasm (arrows) scattered throughout the specimen. (E,F) Actin staining of epiretinal proliferative tissue (×200). No specific staining is observed. (G,H) Anti-CD68 staining of epiretinal proliferative tissue (×500). No specific staining is observed. (I,J) Anti-glial fibrillary acidic protein staining of epiretinal proliferative tissue (×400). Strong positive staining all around the specimen is observed. Epiretinal proliferation tissue acquired from patient 3 (A,C,E,G,I) and patient 4 (B,D,F,H,J).


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