Session Title: Free Paper Session 1: Vitreoretinal Surgery I
Session Date/Time: Thursday 07/09/2017 | 09:00-10:30
Paper Time: 10:06
Venue: Room 111
First Author: : F.Hagenau GERMANY
Co Author(s): : D. Compera J. Ziada S. Guenther A. Wolf S. Priglinger R. Schumann
To characterize the vitreomacular interface immunohistochemically and morphologically in eyes with diabetic macular edema (DME) and to correlate it to SD-OCT classification (sponge like diffuse retinal thickening, cystoid macular edema, serous retinal detachment or a combination of all).
Department of Ophthalmology, Vitreoretinal and Pathology Unit, Ludwig-Maximilians-University Munich, Germany
Epiretinal tissue and internal limiting membrane were harvested from 27 eyes with DME by pars plana vitrectomy. We included 8 patients with non-proliferative diabetic retinopathy (NPDR) and 19 patients with proliferative diabetic retinopathy (PDR). Specimens were processed using combined fluorescence- and transmission electron microscopy (TEM). Epiretinal cells and extracellular matrix components were analysed for 16 specific antigens. Clinical data and spectral-domain optical coherence tomography (SD-OCT) examinations were correlated.
Visual acuity significantly improved by 3 lines during a mean follow-up of 17 months (Wilcoxon: p = 0.03). In SD-OCT we found a hyperreflective, tractive ERM resulting in retinal folds. Sponge like diffuse retinal thickening showed more collagen than the cystoid type, especially directly on the vitreous side of the ILM. The ERM specimens showed a large amount of vitreous collagen. Glial cells, hyalocytes and alpha-SMA-positive myofibroblasts dominated. Matrix metalloproteinases-2 and -9, fibronectin, laminin and collagen I, II, and III were positive tested.
The epiretinal tissue shows cellular components with distinct contractive activity. Remodelling of the vitreous cortex could be demonstrated by the presence of metalloproteinases and newly formed collagen. This process seems to have a pathogenic role in the often difficult to separate vitreous cortex at the vitreoretinal interface during vitrectomy. Patients with diffuse diabetic macular edema and epiretinal membranes usually show improvement of visual acuity after pars plana vitrectomy and membrane peeling.