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The macular hole: histopathologic studies.

W Richard Green1

  • 1The Eye Pathology Laboratory, Wilmer Institute and Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. wrgreen@jhmi.edu

Archives of Ophthalmology (Chicago, Ill. : 1960)
|March 15, 2006
PubMed
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Macular hole surgery tissue analysis reveals internal limiting lamina fragments and cellular changes. Tangential vitreous traction is a primary cause of idiopathic macular holes, with cellular proliferation as a secondary event.

Area of Science:

  • Ophthalmology
  • Surgical Pathology
  • Microscopy

Background:

  • Idiopathic macular holes are a significant cause of vision loss.
  • Understanding the cellular and structural components involved in macular hole formation is crucial for surgical intervention.

Purpose of the Study:

  • To characterize the light and electron microscopic features of tissue obtained during macular hole surgery.
  • To elucidate the pathogenetic mechanisms underlying idiopathic macular holes.

Main Methods:

  • Ocular fluid specimens were concentrated and stained (Papanicolaou, PAS).
  • Surgically isolated tissue was examined using light and electron microscopy.
  • Analysis included identification of vitreous strands, cellular fragments, and retinal internal limiting lamina (ILL).

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Main Results:

  • Vitreous strands, cellular fragments (13.3%), fibrocellular fragments (9.2%), and internal limiting lamina (ILL) fragments (12.8%) were identified.
  • Electron microscopy revealed native and new collagen, ILL (58.7%), and various cells (22.5%), including fibrocytes, astrocytes, and RPE cells.
  • Tissue organization showed cellular layers adjacent to cortical vitreous and ILL.

Conclusions:

  • Tangential traction from fluid movement impacting cortical vitreous is a key factor in idiopathic macular hole pathogenesis.
  • Cellular proliferation is a secondary finding in approximately 22.2% of cases.