Pathogenesis Of Idiopathic Macular Hole Research Articles

Comparison of the morphological characteristics of the choroidal sublayer between idiopathic macular holes and epiretinal membranes with automatic analysis

PurposeTo compare the choroidal sublayer morphologic features between idiopathic macular hole (IMH) and idiopathic epiretinal membrane (iERM) on spectral-domain optical coherent tomography (SD-OCT) using an automatic segmentation model.MethodsThirty-three patients with idiopathic IMHs and 44 with iERMs who underwent vitrectomies were involved. The enhanced depth imaging mode of SD-OCT was used to obtain the B-scan image after single line scanning of the macular fovea. The choroidal sublayer automatic analysis model divides the choroidal into the choroidal large vessel layer, the middle vessel layer and the small vessel layer (LVCL, MVCL and SVCL, respectively) and calculates the choroidal thickness (overall, LVCL, MVCL and SVCL) and vascular index (overall, LVCL, MVCL and SVCL). The morphological characteristics of the choroidal sublayer in the ERM eyes and the IMH eyes were compared.ResultsThe mean choroidal thickness in the macular centre of the IMH eyes was significantly thinner than that of the ERM eyes (206.35 ± 81.72 vs. 273.33 ± 82.31 μm; P < 0.001). The analysis of the choroidal sublayer showed that the MVCL and SVCL macular centres and 0.5–1.5 mm of the nasal and temporal macula were significantly thinner in the IMH eyes than in the ERM eyes (P < 0.05), and there was a difference in the macular centre of the LVCL between the two groups (P < 0.05). In contrast, the choroidal vascular index of the macular centre in the IMH eyes was significantly higher than that in iERM eyes (0.2480 ± 0.0536 vs. 0.2120 ± 0.0616; P < 0.05). There was no significant difference in the CVI of other parts of the macula, the LVCL or MVCL between the two groups.ConclusionThe choroidal thickness of the IMH eyes was significantly thinner than that of the iERM eyes, which was mainly observed in 3 mm of the macular centre and the MVCL and SVCL layers of the choroid. The choroidal vascular index of the IMH eyes was higher than that of the iERM eyes. These findings suggest that the choroid may be involved in the pathogenesis of IMH and iERM.

A proteomic approach to understanding the pathogenesis of idiopathic macular hole formation

Idiopathic macular holes (IMH) are full-thickness defects of retinal tissue that cause severe vision loss due to disruption of the anatomic fovea. Abnormal vitreous traction is involved in the formation of macular holes. Both glial cells and hyalocytes contribute to epiretinal membrane formation in IMH. In order to gain further insight into the pathophysiology of IMH, we conducted a discovery phase investigation of the vitreous proteome in four patients with macular holes and six controls using one-dimensional gel fractionation and liquid chromatography–tandem mass spectrometry analyses on an Orbitrap Elite mass spectrometer. Of a total of 5912 vitreous proteins, 32 proteins had increased and 39 proteins had decreased expression in IMH compared with controls, using a false discovery rate approach with p value < 0.001 and q value < 0.05. IMH was associated with increased expression of proteins in the complement pathway, α-2-macroglobulin, a major inducer of Müller glial cell migration, fibrinogen, and extracellular matrix proteins, and decreased expression of proteins involved in protein folding and actin filament binding. A proteomic approach revealed proteins and biological pathways that may be involved in the pathogenesis of IMH and could be targeted for future studies.

Vitreous estrogen levels in patients with an idiopathic macular hole.

PurposeEstrogen, a female hormone, activates collagenase and might be associated with the pathogenesis of vitreoretinal collagen fiber disease. The purpose of the present study was to investigate the vitreous levels of estrone (E1) and estradiol (E2) in subjects with an idiopathic macular hole (IMH).MethodsVitreous samples were obtained from ten female patients with an IMH and from nine female patients with other retinal diseases (six with rhegmatogenous retinal detachment and three with age-related macular degeneration) as a control at the time of vitreous surgery. E1 and E2 levels in the vitreous samples were then determined using the Coat-A-Count® Estradiol Radioimmunoassay (RIA) Kit and the DSL-70 Estrone RIA Kit, respectively.ResultsThe mean vitreous levels of E1 and E2 in the subjects with IMH were 1.83±2.00 pg/mL and 7.03±2.97 pg/mL, respectively, whereas in the control subjects they were 2.42±1.25 pg/mL and 4.90±2.90 pg/mL, respectively. Thus, the vitreous E2 levels in the subjects with IMH were significantly higher than in the controls (P<0.05).ConclusionThe findings of this study suggest that E2 might be associated with the pathogenesis of IMH, but further investigation is needed to elucidate that association.

Choroidal Thickness in Both Eyes of Patients with Unilateral Idiopathic Macular Hole

To compare the choroidal thickness in the macular area in eyes with an idiopathic macular hole (IMH) with that of unaffected fellow eyes and eyes of healthy controls. A cross-sectional study. Fifty patients with unilateral IMH and 50 healthy controls. Enhanced depth imaging was obtained by spectral-domain optical coherence tomography in all patients and controls. Eyes were divided into 3 groups: 50 eyes in group A (affected eyes with IMH), 48 eyes in group B (unaffected fellow eyes), and 50 eyes in group C (right eyes of age- and sex-matched controls). Two independent graders individually measured the choroidal thickness. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid-scleral junction in the subfoveal area and 1 and 3 mm away from the fovea in the superior, inferior, nasal, and temporal regions. Apical and basal diameters of macular holes (MHs) were measured in eyes with IMH. Statistical analysis was conducted to compare mean choroidal thicknesses. Choroidal thickness was significantly decreased in affected IMH eyes compared with unaffected fellow eyes in 48 patients (P = 0.005, paired t test). The mean subfoveal choroidal thickness (SFCT) was 206.82 ± 67.09 μm in group A, 228.34 ± 80.71 μm in group B, and 248.88 ± 63.10 μm in group C. The choroid was significantly thinner in group A (P = 0.002) than in group C. The SFCT in unaffected fellow eyes was lower than in controls, but without statistical significance (P = 0.177). The apical and basal size of the MH were not related to the underlying choroidal thickness (apical r=-0.267, P = 0.072; basal r = -0.259, P = 0.082). Choroidal thickness was thinner in affected eyes with IMH and in fellow unaffected eyes. This may suggest a contributing role of the perfusion of the choroid in the pathogenesis of IMH. If these findings are confirmed, we suggest that the fellow eyes with thinner choroid may be prone to IMH and should be followed up frequently.

Spielt die Aderhautdicke beim idiopathischen Makulaforamen eine Rolle?

The pathogenesis of idiopathic macular hole (MH) formation is not fully understood and the choroid might be involved in its etiology. Recently published data reported choroidal thickness (CT) to be significantly thinner in eyes with idiopathic MH and in fellow eyes compared to age-matched healthy controls [24]. The enhanced depth imaging (EDI) modus of the Spectralis OCT (Heidelberg Engineering, Heidelberg) was used to measure subfoveal CT in 12 patients with MH of which 2 suffered from bilateral MH. Measurements were manually acquired preoperatively using the horizontal foveal scan of the 7-line scan (5 × 30 perifoveal) with 100 averaged scans per scan, between the outer border of the retinal pigment epithelium and the inner scleral border. Additional CT measurements were obtained 8 weeks and 6 months postoperatively. Subfoveal CT of the 12 patients with MH (10 ♀, 2 ♂; 68 ± 7 years) was 274 ± 65µm. The CT of the 10 patients with healthy fellow eyes measured 268 ± 75µm and CT of the 2 patients with bilateral MH measured 309 ± 34µm in the non-operated eye. The mean axial length (AL) in eyes with MH was 23.64 ± 0.59mm and in healthy fellow eyes 23.68 ± 0.54mm. After surgery MH closure was obvious in all eyes, the postoperative CT at 8 weeks measured 284 ± 77µm and at 6 months 276 ± 73µm. The EDI-OCT procedure enables measurements of CT. In the patients studied a reduced CT could not be found neither in patients with macular holes nor in the fellow eyes. There was no significant change in CT comparing preoperative with postoperative measurements. In contrast to recently published data [24] no reduction in CT in idiopathic macular hole could be demonstrated.

Pathogenesis of idiopathic macular hole based on optical coherence tomograph

Objective To discuss the pathogenesis of idiopathic macular hole (IMH) based on the characteristics of optical coherence tomography (OCT) images.Method The OCT images of IMH in 39 cases (43 eyes) were collected and were divided into different stages according to the standard of Gass.The image of 17 eyes showed atage 2 -4 IMH.They had been performed vitrectomy combined with inner limiting membrane peeling surgery.Results In 5 eyes of stage 1 IMH,traction from posterior vitreous detachment (PVD) at fovea was observed in 4 eyes (80％).In 13 eyes of stage 2 IMH,traction from PVD at fovea was observed in 12 eyes (76.9％).In stage 3 -4 IMH,vitreous have separated from fovea.In which epimacular mebrane was found in 11/16 eyes (68.7％) of stage 3 IMH,and 7/9 eyes (77.8％) of stage 4 IMH.In stage 2 - 4 IMH,cystic lesion had been found at the edge of the hole in each image,curling up like “fish mouth”.But all the cystic lesion and “fish mouth” sign were disappeared after vitrectomy combined with inner limiting membrane peeling.Conclusion In stage 1 of IMH,the main pathogenesis is the fore-and-back traction of PVD at fovea; In stage 3 - 4 IMH,the main pathogenesis is the centrifugal tension from joint action of inner limiting membrance and epimacular membranes.The above two kinds of mechanism are co-existed for the development of the hole in stage 2 IMH. Key words: Macular hole, idiopathic ; Pathogenesis

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Idiopathic Macular Hole: A Cross-sectional Prospective Study

To determine the choroidal thickness in the macular area in patients with idiopathic macular hole in one eye and an unaffected fellow eye and in healthy controls. Cross-sectional, prospective study. Twenty-two patients with a full-thickness unilateral idiopathic macular hole and 22 age- and sex-matched controls were recruited. Enhanced depth imaging optical coherence tomography images were obtained by using spectral-domain optical coherence tomography. The choroidal thickness was measured in the subfoveal area and 1000 μm and 2000 μm away from the fovea in the nasal and temporal regions. The diameter of the macular hole and the axial length were determined. Choroidal thickness was significantly different across the 3 groups at all locations (P < .001, analysis of variance). The choroid was significantly thinner in eyes with idiopathic macular hole and in unaffected fellow eyes than in the control group (P < .01, Tukey-Kramer test). The mean subfoveal choroidal thickness was 183.2 μm in the idiopathic macular hole group, 196.6 μm in the fellow-eye group, and 245.0 μm in the control group. A negative correlation between subfoveal choroidal thickness and axial length was found in all groups (macular hole, r = -0.53, P = .01; fellow eyes, r = -0.56, P < .01; controls, r = -0.52, P = .01); in control eyes, a negative correlation was found between choroidal thickness and age (r = -0.48, P = .02). Choroidal thickness was reduced in eyes with idiopathic macular hole and also in fellow unaffected eyes. This may suggest a contributing role of the choroid in the pathogenesis of idiopathic macular hole.

Macular hole formation, progression, and surgical repair: case series of serial optical coherence tomography and time lapse morphing video study

BackgroundTo use a new medium to dynamically visualize serial optical coherence tomography (OCT) scans in order to illustrate and elucidate the pathogenesis of idiopathic macular hole formation, progression, and surgical closure.Case PresentationsTwo patients at the onset of symptoms with early stage macular holes and one patient following repair were followed with serial OCTs. Images centered at the fovea and at the same orientation were digitally exported and morphed into an Audiovisual Interleaving (avi) movie format. Morphing videos from serial OCTs allowed the OCTs to be viewed dynamically. The videos supported anterior-posterior vitreofoveal traction as the initial event in macular hole formation. Progression of the macular hole occurred with increased cystic thickening of the fovea without evidence of further vitreofoveal traction. During cyst formation, the macular hole enlarged as the edges of the hole became elevated from the retinal pigment epithelium (RPE) with an increase in subretinal fluid. Surgical repair of a macular hole revealed initial closure of the macular hole with subsequent reabsorption of the sub-retinal fluid and restoration of the foveal contour.ConclusionsMorphing videos from serial OCTs are a useful tool and helped illustrate and support anterior-posterior vitreofoveal traction with subsequent retinal hydration as the pathogenesis of idiopathic macular holes.

The Macular Hole

To delineate the light and electron microscopic features of tissue removed at the time of macular hole surgery. The ocular fluid specimens were concentrated using Millipore filters and stained with a modified Papanicolaou and the periodic acid-Schiff stains in 697 cases. In 92 cases, surgically isolated tissue was processed and examined by electron microscopy. The findings in the specimens studied by the Millipore filter technique included vitreous strands; cellular fragments in 108 cases (13.3%); fibrocellular fragments in 75 (9.2%); and fragments of internal limiting lamina (ILL) of the retina in 104 (12.8%). Findings in the 92 specimens with tissue studied by electron microscopy included native vitreous collagen in 48 cases (52.2%); new collagen in 6 (6.5%); native and new collagen in 1 (1.2%); ILL of the retina in 54 (58.7%); and a variety of cells in 22.5% of cases, including fibrocytes, myofibrocytes, fibrous astrocytes with and without myoblastic features, Mueller cells, retinal pigment epithelium with and without myoblastic features, and inflammatory cells. The organization of the tissue elements included a cellular layer along one surface of a layer of cortical vitreous in 18 cases, cortical vitreous along the inner surface of the ILL of the retina in 10, and cortical vitreous sandwiched between the ILL of the retina and a layer of cells in 9. Tangential traction induced by fluid movements affecting the cortical vitreous is a major factor in the pathogenesis of idiopathic macular holes. Cellular proliferation is a secondary change seen in 22.2% of cases.

Optical coherence tomography of the vitreoretinal interface in macular hole formation

AIMSTo image the vitreoretinal interface and provide further information on the pathogenesis of idiopathic macular hole formation.METHODSProspective recruitment of 80 eyes of 41 consecutive patients referred with a diagnosis of...

Operculum in Idiopathic Macular Holes

To detect the factors related to the operculum in idiopathic macular holes and present a pathogenesis of idiopathic macular holes. This study included 583 eyes of idiopathic macular hole that underwent macular hole surgery. To detect the factor related to the operculum, the variables of age, duration of symptoms, hole size, preoperative visual acuity, refraction, axial length, refraction axial length ratio were used for the comparison between two groups and multiple regression. The success rate of surgery and postoperative visual acuity were examined whether the operculum was present or not. The variables that were significantly related to the operculum were as follows: refraction axial length ratio (r = 0.18, p = 0.0092) in women of stage 3, duration of symptoms (r = -0.44, p < 0.001), preoperative visual acuity (r = -0.33, p = 0.0025), and refraction axial length ratio (r = -0.22, p = 0.020) in women of stage 4, and age (r = 0.19, p = 0.047) in men of stage 3. There were no significant differences in the success rate of surgery and postoperative visual acuity whether the operculum was present or not. Generally, operculum tends to occur in aged and round eyes and possibly does not occur in younger and back projected eyes because of retinal fissure. In women of stage 4, the operculum is possibly a torn retina and does not occur in atrophic holes.

Pathogenesis of idiopathic macular holes.

An improvement in our understanding of the pathogenesis and natural history of idiopathic macular holes over the last 10 years has led to a more optimistic and interventionist approach to the surgical management of this vitreoretinal disorder. This article reviews the theories postulated for the pathogenesis of this condition and looks at recent work that has investigated the role of the vitreous, internal limiting membrane, and posterior vitreous detachment in the natural history of macular holes.

Histopathologic Features of Idiopathic Macular Holes and Cysts

The pathogenesis of idiopathic macular holes and cysts is currently debated. The authors studied the histopathologic features of 41 specimens. Of 22 full-thickness holes, 16 (73%) had epiretinal membranes (ERMs), 15 (68%) had cystoid macular edema (CME), and 3 (17%) were sealed by fibroglial and retinal pigment epithelial hyperplasia. Photoreceptors were variably degenerated, for a mean of 480 μm (range, 200-750 μm) from the hole margins. Of 12 lamellar macular holes, 6 (50%) had an ERM exhibiting tangential traction on the internal limiting membrane. Cystoid macular edema was present in, five (71 %) of seven macular cysts, and an ERM was noted in only one (14%). The authors' results suggest that ERM tangential traction may play a role in the pathogenesis of lamellar macular holes. Macular holes often have associated ERMs and CME, which may be potentially reversible.

Involutional Macular Thinning: A Pre-macular Hole Condition

We identified a group of 93 patients (102 eyes) with involutional macular thinning which is a condition that predisposes the affected eyes to developing idiopathic macular holes. The fovea in these patients shows specific architectural changes that can be identified on ophthalmoscopy. On follow-up (mean, 50 months), 26 eyes (27%) developed a macular hole compared to 0% in normal fellow eyes (P < 0.00001). Patients with pigment epithelial window defects on fluorescein angiography (12 of 15 eyes or 80%), or with no posterior vitreous detachment (15 of 34 eyes or 44%) had the highest risk of developing macular holes. There were seven eyes with involutional macular thinning, pigment epithelial window defects on fluorescein angiography and no posterior vitreous detachment; six (86%) developed a macular hole. Macular degeneration, estrogen supplements, cystoid changes (with normal fluorescein angiography), and poor visual acuity did not increase risk. We present a theory for the pathogenesis of idiopathic macular holes.