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Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon
Gisung Son1, Ji Shin Lee2, Suchan Lee1
1Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.
Purpose:
To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue.
Methods:
Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically.
Results:
EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining.
Conclusions:
EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
Insights
Epiretinal proliferation associated with macular hole (EPMH) has a unique morphology and may originate from epithelial cells. Surgeons observed a perifoveal crown phenomenon during EPMH removal in vitrectomy cases.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Macular Diseases
Background:
- Epiretinal proliferation associated with macular hole (EPMH) is an unusual finding.
- Its distinct morphology and origin require further investigation.
Purpose of the Study:
- To describe the unique morphology and origin of EPMH.
- To introduce the perifoveal crown phenomenon observed during EPMH removal.
Main Methods:
- Retrospective analysis of 16 patients with EPMH identified via spectral domain-optical coherence tomography.
- Review of visual acuity, macular morphology, clinical course, and histological analysis of surgical specimens.
Main Results:
- EPMH appeared as amorphous proliferation from the inner/outer segment junction.
- The perifoveal crown phenomenon was observed in all 11 vitrectomized patients.
- Histological analysis suggested an epithelial proliferation origin, with one specimen positive for cytokeratin.
Conclusions:
- EPMH has a distinct, common configuration on OCT.
- An epithelial origin for EPMH is plausible.
- The perifoveal crown phenomenon is a notable intraoperative finding during EPMH removal.
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