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Immunocytochemical Characterization of Macular Hole Opercula
Eric Ezra, FRCS, FRCOphth;
Robert N. Fariss, PhD;
Daniel E. Possin, BS;
William G. Aylward, FRCS, FRCOphth;
Zdenek J. Gregor, FRCS, FRCOphth;
Philip J. Luthert, PhD;
Ann H. Milam, PhD
Arch Ophthalmol. 2001;119:223-231.
Objectives To immunocytochemically characterize the neural and glial elements 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 and processed for transmission electron microscopy, light epifluorescence,
and laser scanning confocal microscopy. Glia were identified using anti–glial
fibrillary acid protein (GFAP), antivimentin, and anti–cellular retinaldehyde
binding protein antibodies. Anti–phosphodiesterase gamma and antirhodopsin
were used for cone and rod photoreceptors, and anticytokeratin was used for
retinal pigment epithelium. The findings were correlated with the clinical
data before and after surgery. For statistical analysis, data were combined
with those of a previous study by the authors of 18 opercula.
Results Opercula from 12 consecutive eyes of 12 patients were studied. In all
opercula, GFAP, vimentin, and cellular retinaldehyde binding protein–positive
glia were present. Six (50%) of 12 opercula contained more than 5 photoreceptors
with somata and internal photoreceptor fibres, but lacking outer segments,
demonstrating strong immunoreactivity to anti-phosphodiesterase gamma without
antirhodopsin reactivity consistent with cones. Further, 2 (17%) of 12 opercula
showed few cones (1-5 cones), and 4 (33%) of 12 contained only glia. Clinicopathologic
correlation of the 30 opercula from the 2 studies showed that eyes with opercula
containing more than 5 photoreceptors were associated with a worse anatomical
closure rate after initial surgery, compared with those with fewer than 5
photoreceptors (P = .004). Once closure had been
achieved with reoperation, median postoperative vision was similar in both
groups (20/40 and 20/60, respectively).
Conclusions A spectrum of opercula occur in FTMH ranging from those containing only
glia to those containing numerous cones. The extent of foveal neuroretinal
tissue loss may affect the outcome of surgery.
From the Vitreoretinal Unit, Moorfields Eye Hospital, London (Drs Ezra,
Aylward, and Gregor); the Department of Pathology, Institute of Ophthalmology,
London, England (Drs Ezra and Luthert); and the Department of Ophthalmology,
University of Washington School of Medicine, Seattle (Dr Fariss, Mr Possin,
and Dr Milam); and the Scheie Eye Institute, University of Pennsylvania, Philadelphia
(Dr Milam).
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