Macular hole opercula. Ultrastructural features and clinicopathological correlation
E. Ezra, P. M. Munro, D. G. Charteris, W. G. Aylward, P. J. Luthert and Z. J. Gregor
Vitreoretinal Unit, Moorfields Eye Hospital, London, England.
OBJECTIVE: To investigate the ultrastructural features of idiopathic
full-thickness macular hole (FTMH) opercula excised during vitrectomy and
to correlate them with the outcome of surgery. METHODS: Opercula were
collected from eyes undergoing vitrectomy for stage 3 FTMH using
noncrushing, cupped foreign body forceps. Following immediate fixation,
specimens were processed for transmission electron microscopy. The
ultrastructural features were correlated with the clinical data recorded
for each patient before and after surgery. RESULTS: Eighteen specimens were
studied. Native vitreous collagen was identified on the surface of all 18,
while fragments of internal limiting membrane were present in 11 (61%).
Eleven (61%) were found to contain only glia, comprising fibrous astrocytes
and Muller cells in variable proportions. The remaining 7 (39%) were found
to contain, in addition to glia, neurites and synaptic complexes, of which
some were typical of cone photoreceptors. The initial surgical closure rate
was significantly better in eyes in which only glia were present (9/11
[82%]), compared with those with neurites (1/7 [14%]) (P = .01). Once
closure had been achieved with reoperation, the median final visual acuity
was 20/60 in both groups (P = .26), although the likelihood of achieving an
acuity of 20/40 or better was greater in the former (50%) than the latter
group (17%). CONCLUSIONS: Two distinct types of opercula occur in
association with stage 3 FTMH--those containing only glia
(pseudo-opercula), which are probably associated with a foveal dehiscence
and little or no loss of foveal tissue, and those containing both glia and
a significant number of avulsed foveal cones (true opercula), which arise
from a full-thickness foveal tear. Although the loss of foveal tissue in
true opercula would seem to explain the worse initial anatomical and more
modest visual results in some eyes, significant visual improvement may
still be achieved after successful closure. The presence of neurites in
true opercula suggests that, in at least some cases, direct traction on the
foveal retina leads to macular hole formation.
Macular pigment levels following successful macular hole surgery
Neelam et al.
Br. J. Ophthalmol. 2005;89:1105-1108.
ABSTRACT
| FULL TEXT
In Vitro Characterization of a Spontaneously Immortalized Human Muller Cell Line (MIO-M1)
Limb et al.
IOVS 2002;43:864-869.
ABSTRACT
| FULL TEXT
Optical coherence tomography of the vitreoretinal interface in macular hole formation
Tanner et al.
Br. J. Ophthalmol. 2001;85:1092-1097.
ABSTRACT
| FULL TEXT
Immunocytochemical Characterization of Macular Hole Opercula
Ezra et al.
Arch Ophthalmol 2001;119:223-231.
ABSTRACT
| FULL TEXT
Idiopathic full thickness macular hole: natural history and pathogenesis
EZRA
Br. J. Ophthalmol. 2001;85:102-109.
FULL TEXT
Watzke-Allen Slit Beam Test in Macular Holes Confirmed by Optical Coherence Tomography
Tanner and Williamson
Arch Ophthalmol 2000;118:1059-1063.
ABSTRACT
| FULL TEXT
Papillofoveal Traction in Macular Hole Formation: The Role of Optical Coherence Tomography
Chauhan et al.
Arch Ophthalmol 2000;118:32-38.
ABSTRACT
| FULL TEXT
Macular Hole Formation: New Data Provided by Optical Coherence Tomography
Gaudric et al.
Arch Ophthalmol 1999;117:744-751.
ABSTRACT
| FULL TEXT
Muller Cell Cone, an Overlooked Part of the Anatomy of the Fovea Centralis: Hypotheses Concerning Its Role in the Pathogenesis of Macular Hole and Foveomacular Retinoschisis
Gass
Arch Ophthalmol 1999;117:821-823.
ABSTRACT
| FULL TEXT
Histopathological Features of Vitreous Removed at Macular Hole Surgery
Sadda et al.
Arch Ophthalmol 1999;117:478-484.
ABSTRACT
| FULL TEXT
Macular Hole Opercula: Ultrastructural Features and Clinicopathologic Correlation
Gass et al.
Arch Ophthalmol 1998;116:965-966.
FULL TEXT
