Related Experiment Video
Updated: Aug 10, 2026
Ex Vivo OCT-Based Multimodal Imaging of Human Donor Eyes for Research into Age-Related Macular Degeneration
Published on: May 26, 2023
The macular hole: histopathologic studies
1The Eye Pathology Laboratory, Wilmer Institute and Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. wrgreen@jhmi.edu
Objective:
To delineate the light and electron microscopic features of tissue removed at the time of macular hole surgery.
Methods:
The ocular fluid specimens were concentrated using Millipore filters and stained with a modified Papanicolaou and the periodic acid-Schiff stains in 697 cases. In 92 cases, surgically isolated tissue was processed and examined by electron microscopy.
Results:
The findings in the specimens studied by the Millipore filter technique included vitreous strands; cellular fragments in 108 cases (13.3%); fibrocellular fragments in 75 (9.2%); and fragments of internal limiting lamina (ILL) of the retina in 104 (12.8%). Findings in the 92 specimens with tissue studied by electron microscopy included native vitreous collagen in 48 cases (52.2%); new collagen in 6 (6.5%); native and new collagen in 1 (1.2%); ILL of the retina in 54 (58.7%); and a variety of cells in 22.5% of cases, including fibrocytes, myofibrocytes, fibrous astrocytes with and without myoblastic features, Mueller cells, retinal pigment epithelium with and without myoblastic features, and inflammatory cells. The organization of the tissue elements included a cellular layer along one surface of a layer of cortical vitreous in 18 cases, cortical vitreous along the inner surface of the ILL of the retina in 10, and cortical vitreous sandwiched between the ILL of the retina and a layer of cells in 9.
Conclusions:
Tangential traction induced by fluid movements affecting the cortical vitreous is a major factor in the pathogenesis of idiopathic macular holes. Cellular proliferation is a secondary change seen in 22.2% of cases.
Insights
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).
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.
