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Clinical and histological features of epiretinal membrane after diabetic vitrectomy

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the clinical, histopathological, and surgical features of the epiretinal membrane (ERM) after diabetic vitrectomy (DV).

Methods

From August 2007 to January 2010, clinical charts of consecutive proliferative diabetic retinopathy (PDR) cases with significant post-DV ERM, defined as thickened membrane causing macular distortion and vision decrease, were enrolled as the study group; PDR cases without post-DV ERM in 24 months follow-up served as the control group. Factors associated with post-DV ERM formation, morphological and visual changes before and after ERM surgery, and histopathological features were analyzed.

Results

Sixteen eyes were in the ERM group, while 60 eyes were in the control group. Active PDR (p < 0.001), fibrovascular proliferation (FVP) grade (p = 0.001), post-DV hemorrhage (p = 0.012), and residual fibrovascular stump (p = 0.002) were factors significantly associated with post-DV ERM. Most membranes (87.5 %) developed within 12 months, were widespread beyond the arcade (81.3 %), and connected with retinal vessels (87.5 %). After surgery, significant VA improvement was achieved. ERM recurrence was noted in six eyes (37.5 %). Histopathological examinations of ERMs in six cases showed abundant collagen fibers with epithelial cells. Immunohistochemical staining with CD 34 demonstrated the presence of vascular endothelium in two of the six specimens.

Conclusion

The post-DV ERM is a complex tissue with variable vascularity that often presents with widespread distribution, rapid progression, and causes macular distortion. Associated risk factors include active PDR, high FVP grade, post-DV hemorrhage, and residual fibrovascular stumps. Membrane removal surgery may be beneficial in selected cases, but recurrence is not uncommon.

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References

  1. Martinez-Castillo V, Boixadera A, Distefano L, Zapata M, Garcia-Arumi J (2012) Epiretinal membrane after pars plana vitrectomy for primary pseudophakic or aphakic rhegmatogenous retinal detachment: incidence and outcomes. Retina 32:1350–1355

    PubMed  Google Scholar 

  2. Karadimas P, Kapetanios A, Panayotidhou E, Bouzas EA (2003) Epiretinal membrane occurring with myelinated retinal nerve fibers and vascular abnormalities. Retina 23:880–881

    Article  PubMed  Google Scholar 

  3. Oh KT, Fammartino JJ (1996) Epiretinal membrane formation. Retina 16:346–347

    Article  CAS  PubMed  Google Scholar 

  4. Okada M, Ogino N, Matsumura M, Honda Y, Nagai Y (1995) Histological and immunohistochemical study of idiopathic epiretinal membrane. Ophthalmic Res 27:118–128

    Article  CAS  PubMed  Google Scholar 

  5. Kono T, Kohno T, Inomata H (1995) Epiretinal membrane formation. Light and electron microscopic study in an experimental rabbit model. Arch Ophthalmol 113:359–363

    Article  CAS  PubMed  Google Scholar 

  6. Messmer E, Bornfeld N, Oehlschlager U, Heinrich T, Foerster MH, Wessing A (1992) Epiretinal membrane formation after pars plana vitrectomy in proliferative diabetic retinopathy. Klin Monatsbl Augenheilkd 200:267–272

    Article  CAS  PubMed  Google Scholar 

  7. Kase S, Saito W, Ohno S, Ishida S (2009) Proliferative diabetic retinopathy with lymphocyte-rich epiretinal membrane associated with poor visual prognosis. Invest Ophthalmol Vis Sci 50:5909–5912

    Article  PubMed  Google Scholar 

  8. Zhao F, Gandorfer A, Haritoglou C, Scheler R, Schaumberger MM, Kampik A, Schumann RG (2013) Epiretinal cell proliferation in macular pucker and vitreomacular traction syndrome: analysis of flat-mounted internal limiting membrane specimens. Retina 33:77–88

    Article  PubMed  Google Scholar 

  9. Yang CM, Yeh PT, Cheng SF, Yang CH, Chen MS (2010) Macular appearance after diabetic vitrectomy for fibrovascular proliferation: an optical coherence tomography study. Acta Ophthalmol (Copenh) 88:193–198

    Article  Google Scholar 

  10. Hosoda Y, Okada M, Matsumura M, Ogino N, Honda Y, Nagai Y (1993) Epiretinal membrane of proliferative diabetic retinopathy: an immunohistochemical study. Ophthalmic Res 25:289–294

    Article  CAS  PubMed  Google Scholar 

  11. Dong Z, Kase S, Ando R, Fukuhara J, Saito W, Kanda A, Murata M, Noda K, Ishida S (2012) Alphab-crystallin expression in epiretinal membrane of human proliferative diabetic retinopathy. Retina 32:1190–1196

    Article  CAS  PubMed  Google Scholar 

  12. Kase S (2011) Correlation with histological findings and visual prognosis in epiretinal membrane of human diabetic retinopathy. Nihon Ganka Gakkai Zasshi 115:998–1006

    PubMed  Google Scholar 

  13. Kase S, Saito W, Ohgami K, Yoshida K, Furudate N, Saito A, Yokoi M, Kase M, Ohno S (2007) Expression of erythropoietin receptor in human epiretinal membrane of proliferative diabetic retinopathy. Br J Ophthalmol 91:1376–1378

    Article  PubMed Central  PubMed  Google Scholar 

  14. Grigorian RA, Castellarin A, Fegan R, Seery C, Del Priore LV, Von Hagen S, Zarbin MA (2003) Epiretinal membrane removal in diabetic eyes: comparison of viscodissection with conventional methods of membrane peeling. Br J Ophthalmol 87:737–741

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Tibbetts MD, Shah CP, Young LH, Duker JS, Maguire JI, Morley MG (2010) Treatment of acute retinal necrosis. Ophthalmology 117:818–824

    Article  PubMed  Google Scholar 

  16. Eliott D, Lee MS, Abrams GS (2006) Proliferative diabetic retinopathy: principles and techniques of surgical treatment. In: Ryan SJ, Hinton DR, Schachat AP, Wilkinson CP (eds) Retina. Elsevier Mosby, Philadelphia, pp 2413–2415

    Chapter  Google Scholar 

  17. Yagi T, Sakata K, Funatsu H, Hori S (2012) Evaluation of perifoveal capillary blood flow velocity before and after vitreous surgery for epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 250:459–460

    Article  PubMed  Google Scholar 

  18. Krepler K, Polska E, Wedrich A, Schmetterer L (2003) Ocular blood flow parameters after pars plana vitrectomy in patients with diabetic retinopathy. Retina 23:192–196

    Article  PubMed  Google Scholar 

  19. Roldan-Pallares M, Rollin R, Mediero A, Martinez-Montero JC, Fernandez-Cruz A, Bravo-Llata C, Fernandez-Durango R (2005) Immunoreactive ET-1 in the vitreous humor and epiretinal membranes of patients with proliferative vitreoretinopathy. Mol Vis 11:461–471

    CAS  PubMed  Google Scholar 

  20. Schoenberger SD, Kim SJ, Sheng J, Rezaei KA, Lalezary M, Cherney E (2012) Increased prostaglandin E2 (PGE2) levels in proliferative diabetic retinopathy, and correlation with VEGF and inflammatory cytokines. Invest Ophthalmol Vis Sci 53:5906–5911

    Article  CAS  PubMed  Google Scholar 

  21. Iannetti L, Accorinti M, Malagola R, Bozzoni-Pantaleoni F, Da Dalt S, Nicoletti F, Gradini R, Traficante A, Campanella M, Pivetti-Pezzi P (2011) Role of the intravitreal growth factors in the pathogenesis of idiopathic epiretinal membrane. Invest Ophthalmol Vis Sci 52:5786–5789

    Article  CAS  PubMed  Google Scholar 

  22. Abu El-Asrar AM, Struyf S, Opdenakker G, Van Damme J, Geboes K (2010) Expression of stem cell factor/c-kit signaling pathway components in diabetic fibrovascular epiretinal membranes. Mol Vis 16:1098–1107

    PubMed Central  PubMed  Google Scholar 

  23. Abu El-Asrar AM, Missotten L, Geboes K (2010) Expression of advanced glycation end products and related molecules in diabetic fibrovascular epiretinal membranes. Clin Exp Ophthalmol 38:57–64

    Article  Google Scholar 

  24. Schwatz SD, Alexander R, Hiscott P, Gregor ZJ (1996) Recognition of vitreoschisis in proliferative diabetic retinopathy. A useful landmark in vitrectomy for diabetic traction retinal detachment. Ophthalmology 103:323–328

    Article  CAS  PubMed  Google Scholar 

  25. Gandorfer A, Rohleder M, Grosselfinger S, Haritoglou C, Ulbig M, Kampik A (2005) Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction. Am J Ophthalmol 139:638–652

    Article  PubMed  Google Scholar 

  26. Bovey EH, Uffer S, Achache F (2004) Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome. Retina 24:728–735

    Article  PubMed  Google Scholar 

  27. Kwok AK, Lai TY, Li WW, Woo DC, Chan NR (2004) Indocyanine green-assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study. Am J Ophthalmol 138:194–199

    Article  PubMed  Google Scholar 

  28. Park DW, Dugel PU, Garda J, Sipperley JO, Thach A, Sneed SR, Blaisdell J (2003) Macular pucker removal with and without internal limiting membrane peeling: pilot study. Ophthalmology 110:62–64

    Article  PubMed  Google Scholar 

  29. Kwok A, Lai TY, Yuen KS (2005) Epiretinal membrane surgery with or without internal limiting membrane peeling. Clin Exp Ophthalmol 33:379–385

    Article  Google Scholar 

  30. Patel JI, Hykin PG, Schadt M, Luong V, Fitzke F, Gregor ZJ (2006) Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina 26:5–13

    Article  PubMed  Google Scholar 

  31. Chang PY, Yang CM, Yang CH, Chen MS, Wang JY (2009) Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling. Eye (Lond) 23:960–965

    Article  Google Scholar 

  32. Yeh PT, Yang CM, Yang CH (2012) Distribution, reabsorption, and complications of preretinal blood under silicone oil after vitrectomy for severe proliferative diabetic retinopathy. Eye (Lond) 26:601–608

    Article  Google Scholar 

  33. Asaria RH, Kon CH, Bunce C, Sethi CS, Limb GA, Khaw PT, Aylward GW, Charteris DG (2004) Silicone oil concentrates fibrogenic growth factors in the retro-oil fluid. Br J Ophthalmol 88:1439–1442

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan

    Yung-Ray Hsu, Chung-May Yang & Po-Ting Yeh

  2. Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Yung-Ray Hsu

  3. National Taiwan University College of Medicine, Taipei, Taiwan

    Chung-May Yang & Po-Ting Yeh

  4. Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan

    Po-Ting Yeh

  5. College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan

    Po-Ting Yeh

Authors
  1. Yung-Ray Hsu
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  2. Chung-May Yang
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  3. Po-Ting Yeh
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Correspondence to Po-Ting Yeh.

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The authors have no commercial or proprietary interests in any product or instrument mentioned in the manuscript.

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Hsu, YR., Yang, CM. & Yeh, PT. Clinical and histological features of epiretinal membrane after diabetic vitrectomy. Graefes Arch Clin Exp Ophthalmol 252, 401–410 (2014). https://doi.org/10.1007/s00417-013-2479-0

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  • DOI: https://doi.org/10.1007/s00417-013-2479-0

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