Epiretinal Cell Proliferation in Macular Pucker and Vitreomacular Traction Syndrome: Analysis of Flat-Mounted Internal Limiting Membrane Specimens

Purpose: To describe new details of epiretinal cell proliferation in flat-mounted internal limiting membrane specimens. Methods: One hundred nineteen internal limiting membrane specimens were removed en bloc with epiretinal membranes from 79 eyes with macular pucker (MP) and 40 eyes with vitreomacular traction syndrome. Intraoperatively, posterior vitreous detachment was assessed as complete or incomplete. Whole specimens were flat-mounted on glass slides and processed for interference and phase-contrast microscopy, cell viability assay, and immunocytochemistry. Results: Mean cell viability percentage was higher in MP than in vitreomacular traction syndrome. Two cell distribution patterns were found. Anti-CD163 labeling presented predominantly in MP with complete posterior vitreous detachment. CD45 expression was similar in all groups of diagnosis. Anti-glial fibrillary acidic protein (GFAP) labeling was found in MP irrespective of the extent of posterior vitreous detachment. Alpha-SMA (alpha-smooth muscle actin) labeling was mainly presented in MP with incomplete posterior vitreous detachment and in vitreomacular traction syndrome. Simultaneous antibody labeling included GFAP/CD45, GFAP/CD163, CD163/CD45, and CD163/alpha-SMA. Conclusion: Hyalocytes constitute a major cell type of epiretinal cell proliferation in eyes with MP and vitreomacular traction syndrome. Glial cells, notably retinal Muller cells, are involved as well. It appears that transdifferentiation of cells in vitreomacular traction might be more frequent than previously thought and that those cells possess a greater variability of immunocytochemical properties than expected. RETINA 33:77-88, 201

Two-step LASIK after penetrating keratoplasty

Aris N Kollias, Markus M Schaumberger, Thomas C Kreutzer, Michael W Ulbig, Carlo A LackerbauerUniversity Eye Hospital, Ludwig-Maximilians University, Munich, GermanyPurpose: The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty.Methods: Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria® LSK one and the Amadeus® 2 microkeratome, laser ablation was performed with the Schwind® Keratome I and the Wavelight® Allegretto WaveEyeQ. Results: Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 ± 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from -4.02 ± 4.77 diopters (D) to -1.11 ± 2.45 D after laser ablation. Mean preoperative manifest astigmatism was -7.27 ± 3.65 D, after lamellar keratotomy -6.72 ± 3.68 D, and after laser ablation -2.08 ± 1.80 D. Manifest astigmatism did not change significantly after the keratotomy.Conclusions: Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.Keywords: two-step, cornea, LASIK, keratoplasty, astigmatis

Epiretinal Cell Proliferation in Macular Pucker and Vitreomacular Traction Syndrome: Analysis of Flat-Mounted Internal Limiting Membrane Specimens

Purpose: To describe new details of epiretinal cell proliferation in flat-mounted internal limiting membrane specimens. Methods: One hundred nineteen internal limiting membrane specimens were removed en bloc with epiretinal membranes from 79 eyes with macular pucker (MP) and 40 eyes with vitreomacular traction syndrome. Intraoperatively, posterior vitreous detachment was assessed as complete or incomplete. Whole specimens were flat-mounted on glass slides and processed for interference and phase-contrast microscopy, cell viability assay, and immunocytochemistry. Results: Mean cell viability percentage was higher in MP than in vitreomacular traction syndrome. Two cell distribution patterns were found. Anti-CD163 labeling presented predominantly in MP with complete posterior vitreous detachment. CD45 expression was similar in all groups of diagnosis. Anti-glial fibrillary acidic protein (GFAP) labeling was found in MP irrespective of the extent of posterior vitreous detachment. Alpha-SMA (alpha-smooth muscle actin) labeling was mainly presented in MP with incomplete posterior vitreous detachment and in vitreomacular traction syndrome. Simultaneous antibody labeling included GFAP/CD45, GFAP/CD163, CD163/CD45, and CD163/alpha-SMA. Conclusion: Hyalocytes constitute a major cell type of epiretinal cell proliferation in eyes with MP and vitreomacular traction syndrome. Glial cells, notably retinal Muller cells, are involved as well. It appears that transdifferentiation of cells in vitreomacular traction might be more frequent than previously thought and that those cells possess a greater variability of immunocytochemical properties than expected. RETINA 33:77-88, 201

Vitrectomy For Intermediate Age-Related Macular Degeneration Associated With Tangential Vitreomacular Traction A Clinicopathologic Correlation

Purpose: To describe the morphologic characteristics of the vitreomacular interface in intermediate age-related macular degeneration associated with tangential traction due to premacular membrane formation and to correlate with optical coherence tomography (OCT) findings and clinical data. Methods: Premacular membrane specimens were removed sequentially with the internal limiting membrane from 27 eyes of 26 patients with intermediate age-related macular degeneration during standard vitrectomy. Specimens were processed for immunocytochemical staining of epiretinal cells and extracellular matrix components. Ultrastructural analysis was performed using transmission electron microscopy. Spectral domain optical coherence tomography images and patient charts were evaluated in retrospect. Results: Immunocytochemistry revealed hyalocytes and myofibroblasts as predominant cell types. Ultrastructural analysis demonstrated evidence of vitreoschisis in all eyes. Myofibroblasts with contractile properties were observed to span between folds of the internal limiting membrane and vitreous cortex collagen. Retinal pigment epithelial cells or inflammatory cells were not detected. Mean visual acuity (Snellen) showed significant improvement from 20/72 +/- 20/36 to 20/41 +/- 20/32 (P < 0.001) after a mean follow-up period of 19 months (median, 17 months). During this period, none of the eyes required anti-vascular endothelial growth factor therapy. Conclusion: Fibrocellular premacular proliferation in intermediate age-related macular degeneration predominantly consists of vitreous collagen, hyalocytes, and myofibroblasts with contractile properties. Vitreoschisis and vitreous-derived cells appear to play an important role in traction formation of this subgroup of eyes. In patients with intermediate age-related macular degeneration and contractile premacular membrane, release of traction by vitrectomy with internal limiting membrane peeling results in significantly functional and anatomical improvement

Evaluation of a short-term topical interferon α-2b treatment for histologically proven melanoma and primary acquired melanosis with atypia

<p><i>Objective</i>: To evaluate the efficiency of series of 6-week treatments with brief intervals (6-week = 1 cycle) of topical Interferon α-2b (IFNα-2b) treatment in primary acquired melanosis (PAM) with atypia and melanoma of the conjunctiva.</p> <p><i>Patients and Methods</i>: Five patients with biopsy-proven PAM with atypia and seven patients with melanoma of the conjunctiva, treated with topical IFNα-2b (1 million units/ml, 5 times daily), were included in the study. All patients had colour photographs and the tumour area was measured manually for each patient before and after treatment.</p> <p><i>Results</i>: The median age of 12 patients at initiation of treatment was 61.5 years (range 39–75 years). The mean therapy duration was 2.4 cycles (range 1-6 cycle).</p> <p>Compared to pretreatment lesion dimension, the mean decrease in tumour size were after the first cycle 66% (range 18–98%; <i>p</i> = 0.004; n = 10 patients), after the second cycle 55% (range 10–100%; <i>p</i> = 0.016; n = 7 patients), and after the third cycle 74% (range 23–100%; n = 3 patients). In one patient 6 cycles of topical IFNα-2b were needed. The decrease in size was 22% after the 4^th cycle, 34% after the 5^th cycle, and 98% after the 6^th cycle.</p> <p><i>Conclusion</i>: Our clinical experience demonstrates promising results of topical IFNα-2b treatment for PAM with atypia and melanoma of the conjunctiva without any local or systemic side effects. However, future multicenter prospective studies are recommended to confirm the efficiency and safety of topical IFNα-2b treatment.</p