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Clinicopathologic correlation of recurrent epiretinal membranes after previous surgical removal
A M Maguire1, W E Smiddy, S K Nanda
1Eye Pathology Laboratory, Wilmer Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Abstract:
Recurrent epiretinal membranes (ERMs) causing macular pucker developed after surgical removal in seven eyes and were subsequently removed. A specimen was available for electron microscopic study from four of the seven primary operations and all seven of the repeat operations. The diagnostic associations for the primary cases included retinal holes or tears (four eyes), trauma, inflammation (one eye each). In one eye the membrane was idiopathic. The primary and recurrent ERM specimens contained similar cell types and structural characteristics but were not identical. No one cell type predominated in either primary or recurrent ERM. Compared with studies of idiopathic ERMs, myofibroblasts were present with increased frequency in recurrent membranes. Fibrocytes, fibrous astrocytes, and retinal pigment epithelial cells were also present in most specimens. Other features of both the primary and recurrent ERM specimens included the presence of cells with myoblastic differentiation, fragments of internal limiting membrane, new collagen, and nerve fiber elements.
Insights
Recurrent epiretinal membranes (ERMs) can develop after surgery for macular pucker. Electron microscopy of recurrent ERMs showed similar but not identical cells to primary ERMs, with more myofibroblasts.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pathology
Background:
- Epiretinal membranes (ERMs) can cause macular pucker, leading to visual distortion.
- Recurrence of ERMs after surgical removal can occur, necessitating further intervention.
Purpose of the Study:
- To investigate the cellular composition and structural characteristics of recurrent epiretinal membranes (ERMs).
- To compare recurrent ERMs with primary ERMs using electron microscopy.
Main Methods:
- Electron microscopic analysis of ERM specimens from primary and repeat surgeries.
- Histopathological examination of tissue samples.
Main Results:
- Recurrent ERM specimens showed similar cell types and structures to primary ERMs, but with distinct differences.
- Myofibroblast presence was increased in recurrent ERMs compared to idiopathic ERMs.
- Commonly identified cells included fibrocytes, fibrous astrocytes, and retinal pigment epithelial cells.
Conclusions:
- Recurrent ERMs share cellular and structural similarities with primary ERMs.
- The increased prevalence of myofibroblasts in recurrent ERMs may contribute to their development.
- Understanding the cellular basis of ERM recurrence can inform future treatment strategies.