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Age-related cellular proliferation at the vitreoretinal juncture
D McLeod1, P S Hiscott, I Grierson
1Surgical Vitreoretinal Unit, Moorfields Eye Hospital, London.
Abstract:
Clinical and pathological features of non-vascularised epiretinal membranes are reviewed with special attention to focal epimacular tractional lesions in the elderly. The role of immunohistochemistry in elucidating the nature of component cells of complex epiretinal membranes is emphasised. Clinicopathological correlation establishes the 'fibroglial membrane' as the causative lesion of age-related epimacular traction. The pathogenesis of this process is discussed, including relevant animal models, and chronic inflammation and ischaemia (rather than acute posterior vitreous detachment) are implicated. Vitrectomy and epimacular membrane peeling results in significant visual improvement in most patients.
Insights
Age-related epimacular traction is caused by fibroglial membranes, not posterior vitreous detachment. Surgical membrane peeling significantly improves vision in elderly patients with these non-vascularised epiretinal membranes.
Area of Science:
- Ophthalmology
- Pathology
- Cell Biology
Background:
- Epiretinal membranes can cause significant visual impairment, particularly in the elderly.
- Focal epimacular tractional lesions are a common cause of decreased vision in older adults.
- Understanding the cellular composition and pathogenesis of these membranes is crucial for effective treatment.
Purpose of the Study:
- To review the clinical and pathological features of non-vascularised epiretinal membranes.
- To investigate the role of immunohistochemistry in identifying cellular components of complex epiretinal membranes.
- To establish the causative lesion of age-related epimacular traction and discuss its pathogenesis.
Main Methods:
- Review of clinical and pathological findings in patients with epiretinal membranes.
- Application of immunohistochemistry to analyze the cellular makeup of epiretinal membranes.
- Clinicopathological correlation to identify the specific lesion responsible for age-related epimacular traction.
- Discussion of pathogenesis, including animal models and implicated factors.
Main Results:
- Clinicopathological correlation identified the 'fibroglial membrane' as the causative lesion of age-related epimacular traction.
- Chronic inflammation and ischemia are implicated in the pathogenesis, rather than acute posterior vitreous detachment.
- Vitrectomy and epimacular membrane peeling led to significant visual improvement in the majority of patients.
Conclusions:
- Age-related epimacular traction is primarily caused by fibroglial membranes.
- The pathogenesis involves chronic inflammation and ischemia.
- Surgical intervention, specifically vitrectomy with membrane peeling, is an effective treatment for improving vision.