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Published on: May 26, 2023
Macular Pigment in Eyes With Macular Hole Formation and Its Change After Surgery
Akira Obana1,2, Risa Nakazawa1, Saki Noma1
1Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu City, Shizuoka, Japan.
Purpose:
To observe the macular pigment (MP) appearances in eyes with macular hole (MH) and clarify the origin of the appearances. The mechanisms underlying the development of MH are discussed based on the observation of MP.
Methods:
This observational case series included 33 eyes of 31 patients with MH who underwent vitrectomy. The MP optical density was measured using the two-wavelength fundus autofluorescence technique. The exact localization of MP was evaluated by comparing MP distribution images and optical coherent tomography B-scan images.
Results:
MP was missing at the MH. The area of the MP defect corresponded with the area of the defect of outer plexiform layer. MP was present in the retinal flap in stage 2 MH that included glia (Müller cells) and plexiform layers and in the operculum in stage 3 MH, which mainly comprised Müller cells. Cystic spaces in the outer plexiform layer surrounding stage 3 and 4 MHs showed a honeycomb appearance on MP images. MP reappeared to form an irregularly shaped pigment plane after surgical closure of MH. The MP optical volume did not change before and after surgery. Fellow eyes with a central dip in MP distribution subsequently developed MH.
Conclusions:
The characteristic appearances of MP at the MH were attributed to MP in the plexiform layers and Müller cell cones. A central dip of MP distribution might be a sign of Müller cell cone damage that proceeds with MH formation.
Translational Relevance:
Observation of MP was useful for understanding the mechanisms of MH formation.
Insights
Macular pigment (MP) is absent at macular holes (MH), but reappears after surgery. A central dip in MP distribution may indicate early Müller cell damage preceding MH development.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Macular Pigment Research
Background:
- Macular holes (MH) are a significant cause of vision loss.
- Understanding the role of macular pigment (MP) in MH pathogenesis is crucial for developing new treatments.
Purpose of the Study:
- To observe macular pigment (MP) appearances in eyes with macular holes (MH).
- To clarify the origin of these MP appearances.
- To discuss the mechanisms of MH development based on MP observations.
Main Methods:
- An observational case series of 33 eyes from 31 patients with MH who underwent vitrectomy.
- MP optical density was measured using two-wavelength fundus autofluorescence.
- MP distribution was compared with optical coherence tomography (OCT) B-scan images.
Main Results:
- MP was absent at the MH, with defects corresponding to outer plexiform layer defects.
- MP was present in the retinal flap (stage 2 MH) and operculum (stage 3 MH).
- Fellow eyes with a central MP dip subsequently developed MH.
Conclusions:
- MP appearances at MH are attributed to MP in plexiform layers and Müller cell cones.
- A central MP dip may indicate Müller cell cone damage preceding MH formation.
- MP observation aids in understanding MH formation mechanisms.
