Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon
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Purpose: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole(EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introducethe perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. Methods: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selectedfrom 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membranebetween January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11,7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. Results: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS)junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, andall exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients,one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despitehole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients werefollowed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not changein one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissuesobtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin orS-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. Conclusions: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
Abstract
Purpose: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole(EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introducethe perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. Methods: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selectedfrom 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membranebetween January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11,7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. Results: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS)junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, andall exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients,one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despitehole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients werefollowed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not changein one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissuesobtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin orS-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. Conclusions: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.
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