Histopathology of the ILM flap and its potential of neuronal remodeling in full-thickness macular holes

Session Details

Session Title: Free Paper Session 1: Vitreoretinal Surgery I

Session Date/Time: Thursday 07/09/2017 | 09:00-10:30

Paper Time: 09:00

Venue: Room 111

First Author: : R.Schumann GERMANY

Co Author(s): :    L. Mautone   C. Haritoglou   D. Compera   F. Hagenau   A. Wolf   S. Priglinger              

Abstract Details


To describe immunocytochemical and ultrastructural characteristics of epiretinal cell proliferation in internal limiting membranes (ILM) flaps obtained from large idiopathic full-thickness macular holes (FTMH).


Interventional investigational case series


ILM flap specimens were harvested from 24 eyes of 24 patients created as recommended for the ILM flap technique during vitrectomy for FTMH of diameter >400┬Ám. We performed interference and phase-contrast microscopy of ILM flat mounts followed by immunostaining and transmission electron microscopy. Specific antigens against glia and ganglion cells as well as antigens against neurothropic growth factors were used. Presence of ILM pores and cell distribution were also documented. Topographic relationship of cells and collagen were demonstrated using electron microscopy.


Cell density showed a broad variety. Immunofluorescence microscopy detected frequent expression of vimentin, glial fibrillary acidic protein, neurofilament, calretinin, melanopsin and neurofilament. Cellular retinaldehyd-binding protein was rare. The presence of glial derived neurotrophic factor and ciliary neurotrophic factor was frequently demonstrated in epiretinal cell proliferation. Electron microscopy revealed cell proliferation on the vitreal side of the ILM, exclusively. Cell fragments on the retinal side of the ILM were rarely seen.


In large FTMH, ILM flap specimens consist of a variable composition of epiretinal cells and vitreous cortex collagen. Preoperatively, the amount of cells and collagen can not be distinguished by current imaging techniques. The presence of neurotrophic growth factors might be of importance for the restoration of visual function when using the ILM flap technique in these cases.

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