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Die vitreoretinale Grenzfläche und ihre Rolle in der Pathogenese vitreomakulärer Erkrankungen

The vitreoretinal interface and its role in the pathogenesis of vitreomaculopathies

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Zusammenfassung

Das vitreoretinale Interface bzw. die vitreoretinale Grenzfläche setzt sich aus der inneren Grenzmembran der Netzhaut, der Glaskörperrinde und einer umgebenden extrazellulären Matrix zusammen. Hyalozyen sind mononukleäre Phagozyten, die in der Glaskörperrinde als einschichtiger Zellverband eingebettet sind. Im Bereich der Makula können im Rahmen der inkompletten hinteren Glaskörperabhebung Adhäsionen der Glaskörperrinde in ihrer gesamten Dicke wie beim vitreomakulären Traktionssyndrom entstehen oder nach lamellärer Aufspaltung der Glaskörperrinde persistieren (Vitreoschisis). Im Rahmen einer inkompletten hinteren Glaskörperabhebung mit Vitreoschisis entstehen relativ dünne hypozelluläre Membranen, wenn die Dissektion innerhalb der Glaskörperrinde hinter der Ebene der als Monolayer angeordneten Hyalozyten erfolgt. Vollzieht sich die Spaltbildung anterior der Hyalozyten, resultieren zellreiche, dicke Membranen. Persistierende vitreopapilläre Adhäsionen begünstigen eine nach außen gerichtete tangentiale Traktion und sind daher oft mit Makulaforamina assoziiert. Nach innen gerichtete Traktion resultiert im Krankheitsbild des „macular pucker“, hier sind persistierende vitreopapilläre Adhäsionen sehr selten.

Abstract

The vitreoretinal interface consists of the inner limiting membrane of the retina, the posterior vitreous cortex, and an intervening extracellular matrix. Hyalocytes are mononuclear phagocytes embedded in the posterior vitreous cortex, in a single layer of sparse density. At the macula, anomalous posterior vitreous detachment (PVD) results in either full-thickness vitreous cortex adhesion with vitreomacular traction syndrome, or partial-thickness adhesion due to vitreoschisis, a split in the posterior vitreous cortex. Anomalous PVD with vitreoschisis splitting behind the level of the monolayer of hyalocytes leaves a relatively thin hypocellular membrane attached to the macula. Vitreoschisis anterior to the level of the hyalocytes leaves a thicker cellular membrane. Persistent vitreopapillary adhesion promotes outward (from the fovea) tangential traction and is therefore associated with macular holes. Inward (centripetal) tangential traction results in macular pucker, almost always in the absence of persistent vitreopapillary adhesion. The English full-text version of this article is available at SpringerLink (under supplemental).

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Sebag gibt an, dass kein Interessenkonflikt besteht. Diese Übersicht beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. VMR Institute for Vitreous Macula Retina, 7677 Center Avenue, suite 400, 92647, Huntington Beach, California, USA

    J. Sebag MD, FACS, FRCOphth, FARVO

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  1. J. Sebag MD, FACS, FRCOphth, FARVO
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Correspondence to J. Sebag MD, FACS, FRCOphth, FARVO.

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Teilweise angelehnt an: Sebag J (Hrsg) (2014) Vitreous – in health and disease. Springer, New York (Vitreous/978-1-4939-1085-4).

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Sebag, J. Die vitreoretinale Grenzfläche und ihre Rolle in der Pathogenese vitreomakulärer Erkrankungen. Ophthalmologe 112, 10–19 (2015). https://doi.org/10.1007/s00347-014-3048-6

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