Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization
AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stab...
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| Format: | Article |
| Language: | English |
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Press of International Journal of Ophthalmology (IJO PRESS)
2021-06-01
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| Series: | International Journal of Ophthalmology |
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| Online Access: | http://ies.ijo.cn/en_publish/2021/6/20210606.pdf |
| _version_ | 1818607109297668096 |
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| author | Andreas Bringmann Martin Karol Jan Darius Unterlauft Thomas Barth Renate Wiedemann Leon Kohen Matus Rehak Peter Wiedemann |
| author_facet | Andreas Bringmann Martin Karol Jan Darius Unterlauft Thomas Barth Renate Wiedemann Leon Kohen Matus Rehak Peter Wiedemann |
| author_sort | Andreas Bringmann |
| collection | DOAJ |
| description | AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD. |
| first_indexed | 2024-12-16T14:21:31Z |
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| institution | Directory Open Access Journal |
| issn | 2222-3959 2227-4898 |
| language | English |
| last_indexed | 2024-12-16T14:21:31Z |
| publishDate | 2021-06-01 |
| publisher | Press of International Journal of Ophthalmology (IJO PRESS) |
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| series | International Journal of Ophthalmology |
| spelling | doaj.art-b4c534ea421e4cb3bf992d6e692e07502022-12-21T22:28:28ZengPress of International Journal of Ophthalmology (IJO PRESS)International Journal of Ophthalmology2222-39592227-48982021-06-0114681883310.18240/ijo.2021.06.0620210606Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilizationAndreas Bringmann0Martin Karol1Jan Darius Unterlauft2Thomas Barth3Renate Wiedemann4Leon Kohen5Matus Rehak6Peter Wiedemann7Peter Wiedemann. Department of Ophthalmology and Eye Hospital, University of Leipzig, Liebigstraße 12, D-04103 Leipzig, Germany. Peter.Wiedemann@medizin.uni-leipzig.deHelios Klinikum Aue, Aue 08280, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, Germany; Helios Klinikum Aue, Aue 08280, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, GermanyDepartment of Ophthalmology and Eye Hospital, University of Leipzig, Leipzig 04103, GermanyAIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.http://ies.ijo.cn/en_publish/2021/6/20210606.pdffoveacystoid macular edemainternal limiting membrane detachmentmüller cell sheen dystrophymüller gliaastrocytes |
| spellingShingle | Andreas Bringmann Martin Karol Jan Darius Unterlauft Thomas Barth Renate Wiedemann Leon Kohen Matus Rehak Peter Wiedemann Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization International Journal of Ophthalmology fovea cystoid macular edema internal limiting membrane detachment müller cell sheen dystrophy müller glia astrocytes |
| title | Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization |
| title_full | Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization |
| title_fullStr | Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization |
| title_full_unstemmed | Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization |
| title_short | Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization |
| title_sort | foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment presumed role of glial cells for foveal structure stabilization |
| topic | fovea cystoid macular edema internal limiting membrane detachment müller cell sheen dystrophy müller glia astrocytes |
| url | http://ies.ijo.cn/en_publish/2021/6/20210606.pdf |
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