Ultrastructure of epiretinal membranes associated with macular holes

Messmer, Elisabeth M.; Heidenkummer, H.-P.; Kampik, Anselm

doi:10.1007/s004170050072

Cited by 103 publications

(40 citation statements)

References 24 publications

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“…Histologically, the appearances of the ERM peeled were comparable to specimens removed in other studies. 16,17 The ERM specimens also showed resemblance in their histological and immunocytochemical characteristics with PHM specimens obtained in a previous study. 7,18 They both contain type IV collagen and GFAP-positive cells.…”

Section: Discussionsupporting

confidence: 66%

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A rationale for membrane peeling in the repair of stage 4 macular holes

Ang

Snead

James

et al. 2005

Eye

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Aim To examine the histological and immunocytochemical characteristics of epiretinal membranes (ERM) associated with stage 4 macular holes (MH) so as to establish a vitreoretinal rationale for surgery in stage 4 MH. Method Consecutive patients with stage 4 MH undergoing vitrectomy and membrane peeling were recruited. Preoperatively, the eyes were examined for ERM formation over the macula and completeness of posterior hyaloid membrane (PHM) separation from the retina. ERM peel specimens obtained during surgery were sent for histological and immunocytochemical studies and were compared with the PHM specimens taken from a previous post-mortem study of eyes with physiological posterior vitreous detachment but without macular holes. Result A total of 13 patients with stage 4 MH fulfilled the inclusion criteria and were recruited. Preoperatively, all eyes had an ERM over the macula and incomplete separation of the PHM seen as a defect in the PHM on specular biomicroscopy. Histologically, the ERM specimens had very similar morphological characteristics to PHM, consisting of an eosinophilic membrane of varying thickness with scattered spindleshaped cells. The membranes stained positively for type IV collagen while the cells were glial fibrillary acidic protein positive. Postoperatively, successful closure of MH was achieved in all cases. Conclusion Stage 4 MH is characterised by incomplete separation of the PHM from the retina with remnants overlying the macula manifesting as ERM. Removal of the ERM is required during vitrectomy in order to relieve the tangential forces involved in the development of MH.

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Section: Discussionsupporting

confidence: 66%

“…The ERM specimens in a series by Messemer et al 16 were found to be highly convoluted, suggesting contracture. Similar contracture has been found in ERMs of macular pucker and cellophane maculopathy.…”

Section: Discussionmentioning

confidence: 90%

A rationale for membrane peeling in the repair of stage 4 macular holes

Ang

Snead

James

et al. 2005

Eye

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“…Age (P ¼ 0.11) and the number of quadrants of FVP involvement (P ¼ 0. 22) were not found to be associated with visual outcome.…”

Section: Resultsmentioning

confidence: 68%

“…9 Removal of the ILM may prevent later ERM formation by removing a scaffold for proliferating astrocytes and myofibroblasts. 12,22 Furthermore, removal of the ILM guarantees complete separation of the posterior hyaloid from the macular surface. One study has shown that even after triamcinolone-assisted PPV, residual posterior hyaloid can still be found on the ILM by transmission electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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Objective To evaluate the anatomical and functional results of internal limiting membrane (ILM) peeling during pars plana vitrectomy for fibrovascular proliferation (FVP) in diabetic retinopathy. Methods The study was a prospective comparative case series in design. Patients undergoing pars plana vitrectomy for mild to moderate diabetic FVP were divided into either Group 1: vitrectomy only, or Group 2: further ILM peeling in the macular area. Best-corrected visual acuity, fundus examination, and optical coherence tomography (OCT) were conducted at 3 and 6 months postoperatively. Results There were 26 eyes of 25 patients in Group 1 (non-ILM peeling) and 23 eyes of 22 patients in Group 2 (ILM peeling). At 6 months postoperatively, OCT-identifiable epiretinal membrane (ERM) was found in 10 of 26 eyes (38.5%) in Group 1and 0 of 23 eyes in Group 2 (P ¼ 0.001) and six eyes (23.1%) in Group 1 developed biomicroscopic ERM, whereas no patients in Group 2 had ERM (P ¼ 0.02) at 6 months. OCT identifiable ERM correlated significantly with central macular thickness (r ¼ À0.58, Po0.001), the presence of intraretinal cystic space (r ¼ 0.60, Po0.001), and fovea depression reappearance (r ¼ 0.36, P ¼ 0.008). Factors associated with poor visual outcome were macular detachment (Po0.001) and non-ILM peeling (P ¼ 0.004). Conclusions This pilot study suggests that ILM peeling during vitrectomy for diabetic fibrovascular proliferative membranes may minimize postoperative ERM formation and improve visual prognosis.

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“…La matriz extracelular de las membranas vitreorretinianas y epirretinianas contiene abundante fibronectina y laminina (4,5), y están en permanente formación y degradación biológica. La cascada proteolítica mediada por activación del plasminóge-no, a través de la formación de plasmina, es un importante mecanismo proteolítico de la degradación fisiológica en la dinámica permanente de remodelación tisular de la matriz extracelular de dichas membranas (6).…”

Section: Introductionunclassified

Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular

Díaz-Llopis

Udaondo²,

Cervera

et al. 2009

Arch Soc Esp Oftalmol

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RESUMENObjetivo: Determinar si la inyección intravítrea de plasmina es efectiva en el tratamiento de las membranas epirretinianas maculares (MEM) y el síndro-me de tracción vitreomacular (STVM), sin necesidad de asociar vitrectomía quirúrgica. Material y métodoDiseño: Estudio piloto prospectivo, de intervención, serie de casos. Pacientes: Siete pacientes, cuatro con membrana epirretiniana macular y tres con síndrome de tracción vitreomacular. ABSTRACTPurpose: To determine the effectiveness of intravitreal plasmin injection in the treatment of macular epiretinal membranes (MEM) and vitreomacular traction syndrome (VMTS) without associated pars plana vitrectomy. Methods:Design: Interventional, prospective, case series pilot study. Patients: Seven patients were enrolled in the study, 4 with MEM and 3 with VMTS. Treatment: 0.2 ml of autologous plasmin intravitreally injected under topical anesthesia was administered

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Ultrastructure of epiretinal membranes associated with macular holes

Cited by 103 publications

References 24 publications

A rationale for membrane peeling in the repair of stage 4 macular holes

A rationale for membrane peeling in the repair of stage 4 macular holes

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Vitrectomía enzimática por inyección intravítrea de plasmina autóloga como tratamiento inicial de las membranas epirretinianas maculares y el síndrome de tracción vitreomacular

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