IMMUNOMORPHOLOGICAL FEATURES OF IDIOPATHIC EPIRETINAL MEMBRANES COMPLICATED BY LAMELLAR MACULAR HOLE

Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear.Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear

Strategy for the management of complex retinal detachments: the European vitreo-retinal society retinal detachment study report 2

OBJECTIVE: To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs). DESIGN: Nonrandomized, multicenter, retrospective study. PARTICIPANTS: One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs. METHODS: Reported data included clinical manifestations, the method of repair, and the outcome. MAIN OUTCOME MEASURES: Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate). RESULTS: The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)). CONCLUSIONS: In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1

OBJECTIVE: To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs). DESIGN: Nonrandomized, multicenter retrospective study. PARTICIPANTS: One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs. METHODS: Reported data included specific clinical findings, the method of repair, and the outcome after intervention. MAIN OUTCOME MEASURES: Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate). RESULTS: Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10(-8)). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034). CONCLUSIONS: In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful