Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability
Abstract Background The pathogenesis of partial-thickness macular defects and the role of Müller glial cells in the development of such defects are not well understood. We document the morphological characteristics of various types of partial-thickness macular defects using spectral-domain optical c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | International Journal of Retina and Vitreous |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40942-020-00232-1 |
| _version_ | 1818657139415056384 |
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| author | Andreas Bringmann Jan Darius Unterlauft Renate Wiedemann Matus Rehak Peter Wiedemann |
| author_facet | Andreas Bringmann Jan Darius Unterlauft Renate Wiedemann Matus Rehak Peter Wiedemann |
| author_sort | Andreas Bringmann |
| collection | DOAJ |
| description | Abstract Background The pathogenesis of partial-thickness macular defects and the role of Müller glial cells in the development of such defects are not well understood. We document the morphological characteristics of various types of partial-thickness macular defects using spectral-domain optical coherence tomography, with the focus on tractional and degenerative lamellar holes, and discuss possible pathogenic mechanisms. Methods A retrospective case series of 61 eyes of 61 patients with different types of partial-thickness macular defects is described. Results Partial-thickness macular defects are caused by anteroposterior or tangential traction onto the fovea exerted by the partially detached posterior hyaloid and epiretinal membranes, respectively. Tractional elevation of the inner Müller cell layer of the foveola—without (outer lamellar holes, foveal pseudocysts) or with a disruption of this layer (tractional lamellar holes, macular pseudoholes)—produces an elevation of the inner layers of the foveal walls (nerve fiber layer to outer plexiform layer [OPL]) and a schisis between the OPL and Henle fiber layer (HFL). With the exception of outer lamellar holes, the (outer part of the) central outer nuclear layer and the external limiting membrane remain nondisrupted in the various types of partial-thickness defects. Degenerative lamellar holes are characterized by cavitations between the inner plexiform layer and HFL of the foveal walls; many cases have lamellar hole-associated epiretinal proliferation (LHEP). Proliferating cells of the disrupted Müller cell cone may contribute to the development of LHEP and fill the spaces left by degenerated photoreceptors in the foveal center. Conclusions It is suggested that morphological characteristics of partial-thickness macular defects can be explained by the disruption of the (stalk of the) Müller cell cone in the foveola and the location of tissue layer interfaces with low mechanical stability: the boundary with no cellular connections between both Müller cell populations in the foveola, and the interface between the OPL and HFL in the foveal walls and parafovea. We propose that the development of the cavitations in degenerative lamellar holes is initiated by traction which produces a schisis between the OPL and HFL, and enlarged by a slow and chronic degeneration of Henle fibers and bipolar cells. Trial registration retrospectively registered, #143/20-ek, 04/03/2020 |
| first_indexed | 2024-12-17T03:36:44Z |
| format | Article |
| id | doaj.art-3b574d31514a494293e4f3c6a9c31345 |
| institution | Directory Open Access Journal |
| issn | 2056-9920 |
| language | English |
| last_indexed | 2024-12-17T03:36:44Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Retina and Vitreous |
| spelling | doaj.art-3b574d31514a494293e4f3c6a9c313452022-12-21T22:05:06ZengBMCInternational Journal of Retina and Vitreous2056-99202020-07-016111710.1186/s40942-020-00232-1Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stabilityAndreas Bringmann0Jan Darius Unterlauft1Renate Wiedemann2Matus Rehak3Peter Wiedemann4Department of Ophthalmology and Eye Hospital, University of LeipzigDepartment of Ophthalmology and Eye Hospital, University of LeipzigDepartment of Ophthalmology and Eye Hospital, University of LeipzigDepartment of Ophthalmology and Eye Hospital, University of LeipzigDepartment of Ophthalmology and Eye Hospital, University of LeipzigAbstract Background The pathogenesis of partial-thickness macular defects and the role of Müller glial cells in the development of such defects are not well understood. We document the morphological characteristics of various types of partial-thickness macular defects using spectral-domain optical coherence tomography, with the focus on tractional and degenerative lamellar holes, and discuss possible pathogenic mechanisms. Methods A retrospective case series of 61 eyes of 61 patients with different types of partial-thickness macular defects is described. Results Partial-thickness macular defects are caused by anteroposterior or tangential traction onto the fovea exerted by the partially detached posterior hyaloid and epiretinal membranes, respectively. Tractional elevation of the inner Müller cell layer of the foveola—without (outer lamellar holes, foveal pseudocysts) or with a disruption of this layer (tractional lamellar holes, macular pseudoholes)—produces an elevation of the inner layers of the foveal walls (nerve fiber layer to outer plexiform layer [OPL]) and a schisis between the OPL and Henle fiber layer (HFL). With the exception of outer lamellar holes, the (outer part of the) central outer nuclear layer and the external limiting membrane remain nondisrupted in the various types of partial-thickness defects. Degenerative lamellar holes are characterized by cavitations between the inner plexiform layer and HFL of the foveal walls; many cases have lamellar hole-associated epiretinal proliferation (LHEP). Proliferating cells of the disrupted Müller cell cone may contribute to the development of LHEP and fill the spaces left by degenerated photoreceptors in the foveal center. Conclusions It is suggested that morphological characteristics of partial-thickness macular defects can be explained by the disruption of the (stalk of the) Müller cell cone in the foveola and the location of tissue layer interfaces with low mechanical stability: the boundary with no cellular connections between both Müller cell populations in the foveola, and the interface between the OPL and HFL in the foveal walls and parafovea. We propose that the development of the cavitations in degenerative lamellar holes is initiated by traction which produces a schisis between the OPL and HFL, and enlarged by a slow and chronic degeneration of Henle fibers and bipolar cells. Trial registration retrospectively registered, #143/20-ek, 04/03/2020http://link.springer.com/article/10.1186/s40942-020-00232-1Macular defectLamellar holeVitreofoveal tractionEpiretinal membraneFoveaMüller glia |
| spellingShingle | Andreas Bringmann Jan Darius Unterlauft Renate Wiedemann Matus Rehak Peter Wiedemann Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability International Journal of Retina and Vitreous Macular defect Lamellar hole Vitreofoveal traction Epiretinal membrane Fovea Müller glia |
| title | Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability |
| title_full | Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability |
| title_fullStr | Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability |
| title_full_unstemmed | Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability |
| title_short | Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability |
| title_sort | morphology of partial thickness macular defects presumed roles of muller cells and tissue layer interfaces of low mechanical stability |
| topic | Macular defect Lamellar hole Vitreofoveal traction Epiretinal membrane Fovea Müller glia |
| url | http://link.springer.com/article/10.1186/s40942-020-00232-1 |
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