Identification of epiretinal proliferation in various retinal diseases and vitreoretinal interface disorders

Abstract

Background: To describe the presence of epiretinal proliferation in eyes with various retinal and vitreoretinal interface conditions. Methods: Consecutive patients seen at the Stein Eye Institute, by one retina specialist, from December 2018 to March 2019, and demonstrating epiretinal proliferation on optical coherence tomography (OCT) were enrolled in this cross-sectional study. Included patients were divided into two groups: vitreoretinal interface pathologies group or retinal diseases group. Presence of epiretinal proliferation and its localization within the 9 macular sectors, as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS), were assessed on OCT. Results: 77 eyes from 69 patients demonstrated epiretinal proliferation on OCT. The most frequently involved ETDRS sector was the 1-mm central subfield, followed by inner temporal and inner nasal sectors. Localization of epiretinal proliferation correlated with the presence of any retinal abnormalities in the same quadrant (r = 0.962; P < 0.0001). 31 eyes (40.3%) demonstrated symptomatic vitreoretinal interface pathologies including lamellar macular hole, full-thickness macular hole, epiretinal membrane and history of macular peeling. 46 eyes (59.7%) manifested various retinal diseases, including age-related macular degeneration, diabetic retinopathy, refractory macular edema, vein occlusion and high myopia. Conclusions: Epiretinal proliferation was noted in several retinal conditions and not limited only to full-thickness and lamellar macular holes. Different mechanisms affecting retinal homeostasis might trigger Müller cells dysregulation, potentially leading to abnormal retinal remodeling.

Surgical outcomes in patients with lamellar macular holes selected based on the optical coherence tomography consensus definition

“…Histologically and immunohistochemically, glial cells and in particular Müller cells have been found in this proliferative material, supporting the assumption that it could originate from the middle retinal layers and that its development could be triggered by the presence of an inner retinal break in LMH eyes [ 27 ]. These findings could explain the high occurrence rate, up to 50%, of post-operative FTMH in previous series on LMH surgery [ 4 – 6 , 25 ]. Indeed, we assumed that, in these cases, FTMH formation was secondary to a rupture of the outer retinal layers by direct traction on this proliferative tissue.…”

“…Indeed, while there is no doubt about the benefit of ERM peeling for macular pseudoholes and ERM foveoschisis, LMH surgery remains controversial with inconsistent outcomes [ 3 , 4 , 6 , 15 , 24 ]. Prior LMH studies based on the earlier classification could have included cases of MPH and ERM foveoschisis, and could therefore have reported better surgical outcomes than usually found, while using conventional macular peeling approaches [ 19 , 21 – 23 , 25 ].…”

Primary Lamellar Macular Holes: To Vit or Not to Vit

“…Although initially associated with LMH, this epiretinal proliferation has also been described in other conditions like FTMH, ERM and other inflammatory, degenerative and vascular diseases [ 48 , 50 ]. Up to 25% of eyes with a FTMH demonstrate the presence of LHEP [ 46 , 51 ].…”

Increased Macrophage-like Cell Density in Retinal Vein Occlusion as Characterized by Swept-Source Optical Coherence Tomography Angiography

“…The cellular composition of these structures was unable to be determined in the current study. A previous study observed epiretinal proliferation at the vitreoretinal interface in RVO eyes [29]. Meanwhile, other studies showed that immunity and inflammation in the retina were involved in complications secondary to RVO, such as ERM and retinal atrophy [3,21,[30][31][32].…”