1
|
van Overdam KA, Veckeneer M, Kiliç E, van Etten PG, Sebag J, van Meurs JC. Vitreoschisis-induced vitreous cortex remnants in proliferative vitreoretinopathy: A comprehensive review from basic research to clinical practice. Acta Ophthalmol 2024. [PMID: 39262083 DOI: 10.1111/aos.16755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024]
Abstract
Proliferative vitreoretinopathy (PVR) significantly impacts the prognosis of rhegmatogenous retinal detachment (RRD), one of the most critical and increasing causes of vision loss in the Western world. Despite advancements in surgical instruments and techniques, the failure rate due to PVR remains substantial, necessitating additional surgeries and often leading to unsatisfactory visual outcomes. This comprehensive review explores the role of vitreoschisis-induced vitreous cortex remnants (VCR) as a critical, previously under-recognised factor contributing to PVR. Vitreoschisis, a phenomenon where the inner lamellae of the posterior vitreous cortex detach while the outermost layers remain attached to the retina, creates VCR that may contain hyalocytes and serve as scaffolds for fibrocellular proliferation. These remnants are difficult to visualise without triamcinolone acetonide (TA) staining, leading to their frequent lack of recognition in clinical practice. Moreover, removing VCR can be challenging and time-consuming, often requiring meticulous surgical techniques to avoid retinal damage and ensure complete elimination. This review consolidates insights from basic research and clinical practice, emphasising the importance of complete vitreous removal and effective VCR detection and removal to mitigate PVR risks. It highlights the histopathological and clinical evidence supporting the hypothesis that VCR, containing hyalocytes, play a pivotal role in preretinal membrane formation. The review also discusses epidemiological data, surgical management strategies and potential future directions, including improved visualisation techniques and the development of new surgical tools and methods. This review aims to improve surgical outcomes and reduce the frequency and burden of RRD-related complications by addressing VCR as a critical factor in PVR.
Collapse
Affiliation(s)
- Koen A van Overdam
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Marc Veckeneer
- Department of Vitreoretinal Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Emine Kiliç
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jerry Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
- Doheny Eye Institute, Pasadena, California, USA
| | | |
Collapse
|
2
|
Lange C, Boneva S, Wieghofer P, Sebag J. Hyalocytes-guardians of the vitreoretinal interface. Graefes Arch Clin Exp Ophthalmol 2024; 262:2765-2784. [PMID: 38568222 PMCID: PMC11377362 DOI: 10.1007/s00417-024-06448-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 09/06/2024] Open
Abstract
Originally discovered in the nineteenth century, hyalocytes are the resident macrophage cell population in the vitreous body. Despite this, a comprehensive understanding of their precise function and immunological significance has only recently emerged. In this article, we summarize recent in-depth investigations deciphering the critical role of hyalocytes in various aspects of vitreous physiology, such as the molecular biology and functions of hyalocytes during development, adult homeostasis, and disease. Hyalocytes are involved in fetal vitreous development, hyaloid vasculature regression, surveillance and metabolism of the vitreoretinal interface, synthesis and breakdown of vitreous components, and maintenance of vitreous transparency. While sharing certain resemblances with other myeloid cell populations such as retinal microglia, hyalocytes possess a distinct molecular signature and exhibit a gene expression profile tailored to the specific needs of their host tissue. In addition to inflammatory eye diseases such as uveitis, hyalocytes play important roles in conditions characterized by anomalous posterior vitreous detachment (PVD) and vitreoschisis. These can be hypercellular tractional vitreo-retinopathies, such as macular pucker, proliferative vitreo-retinopathy (PVR), and proliferative diabetic vitreo-retinopathy (PDVR), as well as paucicellular disorders such as vitreo-macular traction syndrome and macular holes. Notably, hyalocytes assume a significant role in the early pathophysiology of these disorders by promoting cell migration and proliferation, as well as subsequent membrane contraction, and vitreoretinal traction. Thus, early intervention targeting hyalocytes could potentially mitigate disease progression and prevent the development of proliferative vitreoretinal disorders altogether, by eliminating the involvement of vitreous and hyalocytes.
Collapse
Affiliation(s)
- Clemens Lange
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany.
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Wieghofer
- Cellular Neuroanatomy, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, CA, USA.
- Doheny Eye Institute, UCLA, Pasadena, CA, USA.
- Department of Ophthalmology, Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| |
Collapse
|
3
|
van Overdam KA, van Etten PG, Accou GPBM, Wubbels RJ, van Meurs JC, Verhoekx JSN. Prevalence of vitreoschisis-induced vitreous cortex remnants over the peripheral retinal surface in eyes undergoing vitrectomy for primary rhegmatogenous retinal detachment. Acta Ophthalmol 2024; 102:99-106. [PMID: 37133363 DOI: 10.1111/aos.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE Unremoved vitreoschisis-induced vitreous cortex remnants over the peripheral retinal surface posterior to the vitreous base (pVCR) may increase the risk of surgical failure after primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this study was to validate our previous findings on pVCR prevalence during vitrectomy for RRD and to examine their association with proliferative vitreoretinopathy (PVR) and surgical failure. METHODS Prospective observational multisurgeon study of 100 eyes of 100 consecutive patients who underwent vitrectomy for RRD by one of four vitreoretinal surgeons. Collected data included detected pVCR and known PVR risk factors. Pooled analysis with our previous retrospective study (251 eyes of 251 patients) was also performed. RESULTS Initial PVR (≥C) was present and removed in 6/100 (6%) patients, pVCR were detected in 36/100 (36%) patients, pVCR were removed in 30/36 (83%) patients with pVCR, and 4/36 (11%) patients with pVCR were high myopes (≤-6D). Six per cent (6/100) developed a retinal redetachment, of which 3/6 (50%) had initial PVR (≥C). Surgical failure rates in eyes with and without pVCR were 17% (6/36) and 0% (0/64), respectively. In eyes with pVCR and surgical failure, pVCR were not or not completely removed during the first surgery. Overall analysis showed that pVCR were statistically significantly associated with PVR. CONCLUSIONS This study confirms our previous findings: a pVCR prevalence of around 35% and an association between pVCR, PVR formation and surgical failure in patients undergoing vitrectomy for RRD. More research is needed to determine which patients would benefit most from pVCR removal.
Collapse
Affiliation(s)
- Koen A van Overdam
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Peter G van Etten
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Geraldine P B M Accou
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - René J Wubbels
- Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Jan C van Meurs
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Jennifer S N Verhoekx
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Hwang SH, Lee DY, Nam DH. Vitreous Cortex Remnants Removal With Beveled Vitrectomy Probe During Vitrectomy For Primary Rhegmatogenous Retinal Detachment. Retina 2023; 43:2173-2176. [PMID: 36913622 DOI: 10.1097/iae.0000000000003779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To introduce a new surgical technique with a beveled vitrectomy probe for the removal of peripheral vitreous cortex remnants (VCR) in primary rhegmatogenous retinal detachment (RRD). METHODS This study was a retrospective case series. From September 2019 to June 2022, 54 patients with complete or partial posterior vitreous detachment who underwent vitrectomy for primary RRD by a single surgeon were enrolled. RESULTS After staining the vitreous with triamcinolone acetonide, the presence of VCR was assessed in detail. If VCR were present, the macular VCR were removed using surgical forceps, and then, a free flap of peripheral VCR was used as a handle for removing peripheral VCR using the beveled vitrectomy probe. Of the total patients, the presence of VCR was confirmed in 16 patients (29.6%). There were no intraoperative or postoperative complications, except for retinal redetachment caused by proliferative vitreoretinopathy, that occurred in only one eye (1.9%). CONCLUSION Using a beveled vitrectomy probe was a practical solution for removing VCR during RRD vitrectomy because additional instruments were not needed and risk of iatrogenic retinal damage was low.
Collapse
Affiliation(s)
- Sung Ha Hwang
- Department of Ophthalmology, Gil Medical Center, College of Medicine, Gachon University, Incheon, Korea
| | | | | |
Collapse
|
5
|
Jones CH, Gui W, Schumann RG, Boneva S, Lange CAK, van Overdam K, Chui TYP, Rosen RB, Engelbert M, Sebag J. Hyalocytes in proliferative vitreo-retinal diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 17:263-280. [PMID: 36466118 PMCID: PMC9718005 DOI: 10.1080/17469899.2022.2100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
Abstract
Introduction Hyalocytes are sentinel macrophages residing within the posterior vitreous cortex anterior to the retinal inner limiting membrane (ILM). Following anomalous PVD and vitreoschisis, hyalocytes contribute to paucicellular (vitreo-macular traction syndrome, macular holes) and hypercellular (macular pucker, proliferative vitreo-retinopathy, proliferative diabetic vitreo-retinopathy) diseases. Areas covered Studies of human tissues employing dark-field, phase, and electron microscopy; immunohistochemistry; and in vivo imaging of human hyalocytes. Expert opinion Hyalocytes are important in early pathophysiology, stimulating cell migration and proliferation, as well as subsequent membrane contraction and vitreo-retinal traction. Targeting hyalocytes early could mitigate advanced disease. Ultimately, eliminating the role of vitreous and hyalocytes may prevent proliferative vitreo-retinal diseases entirely.
Collapse
Affiliation(s)
| | - Wei Gui
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | | | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens AK Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | | | - Toco YP Chui
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York; NYU School of Medicine, New York, USA
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
- Doheny Eye Institute, UCLA, Pasadena, California, USA
| |
Collapse
|
6
|
Wakabayashi T, Mahmoudzadeh R, Salabati M, Garg SJ, Ho AC, Spirn MJ. Utility of Removal of Vitreous Cortex Remnants during Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair. Curr Eye Res 2022; 47:1444-1449. [PMID: 35838170 DOI: 10.1080/02713683.2022.2103154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the prevalence of vitreous cortex remnants (VCR) in primary rhegmatogenous retinal detachment (RRD) and the utility of VCR removal using diamond-dusted membrane scrapers (DDMS) during pars plana vitrectomy (PPV). METHODS One hundred and eighty-seven eyes (187 consecutive patients) were retrospectively studied. We evaluated the prevalence of VCR on the retinal surface extending from the macula to outside the vascular arcade in eyes that underwent PPV for primary RRD by a single surgeon between July 2014 and February 2021. The VCR outside the vascular arcade was completely removed using a DDMS. Preoperative factors and surgical outcomes were compared between eyes with VCR removed intraoperatively to those without VCR. RESULTS VCR was present and removed (group A) in 86 (46%) eyes and absent (group B) in 101 (54%) eyes. Patients with VCR were significantly older than those without (P = 0.006). The preoperative BCVA (logMAR) tended to be worse in group A (1.23 ± 0.92 [Snellen equivalent, 20/340]) than in group B (1.03 ± 0.89 [20/214]), however, the difference was not statistically significant (P = 0.095). There were no between-group differences in postoperative BCVA (group A; 0.44 ± 0.54 [20/55]; group B; 0.42 ± 0.50 [20/53]; P = 0.38). Single surgery anatomic success (group A; 90%, group B; 91%, P = 0.573) and the incidence of postoperative PVR (group A; 9%, group B; 6%, P = 0.554) were comparable between the groups. CONCLUSIONS Nearly half of the patients had VCR, which was more likely to occur in older patients. VCR removal resulted in favorable functional and anatomic outcomes similar to those in eyes without any VCR in patients with RRD.
Collapse
Affiliation(s)
- Taku Wakabayashi
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mirataollah Salabati
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marc J Spirn
- Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
van Overdam KA, van den Bosch TPP, van Etten PG, Uppal GS, Veckeneer M, Verdijk RM. Novel insights into the pathophysiology of proliferative vitreoretinopathy: The role of vitreoschisis-induced vitreous cortex remnants. Acta Ophthalmol 2022; 100:e1749-e1759. [PMID: 35673878 DOI: 10.1111/aos.15197] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We previously hypothesized a causal relationship between vitreoschisis-induced vitreous cortex remnants (VCR) and the development of proliferative vitreoretinopathy (PVR). This study aims to substantiate this association through histopathological analysis of surgical specimens in support of strategies to improve therapeutic outcomes. METHODS A descriptive, prospective, non-consecutive case series. Histopathological and immunohistochemical analyses were performed on membranes removed from the peripheral retinal surface during initial vitrectomy for primary rhegmatogenous retinal detachment (RRD) (n = 11) or recurrent retinal detachment (n = 12). The clinical aspect of the membranes ranged from loose-meshed membranes visualized with triamcinolone to more fibrotic membranes stained with trypan blue. RESULTS Consistent with the clinical presentation, histopathological analysis revealed membranes with different area characteristics. Paucicellular lamellar collagen-rich areas, suggestive of VCR, appeared to transition to areas of increased cellularity and eventually more fibrotic areas of low cellularity. Five different area characteristics could be identified that seemed to correspond to five histopathological stages in PVR formation, with lamellar VCR collagen acting as an essential precondition: 1. Lamellar collagen, low cellularity (hyalocytes). 2. Lamellar collagen, increased cellularity (hyalocytes, glial cells). 3. Lamellar collagen, high cellularity (macrophages, glial cells, RPE-cells). 4. Early fibrosis, decreased cellularity (myofibroblasts). 5. Fibrosis, low cellularity (myofibroblasts). CONCLUSION These findings confirm the role of VCR in preretinal PVR formation posterior to the vitreous base. We propose that the presence of VCR over the retinal surface should be qualified as a risk factor for PVR formation. Detection and adequate removal of VCR may improve the success rate of vitreoretinal surgeries.
Collapse
Affiliation(s)
- Koen A van Overdam
- Department of Vitreoretinal Surgery, the Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Thierry P P van den Bosch
- Department of Pathology, Section Ophthalmic Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter G van Etten
- Department of Vitreoretinal Surgery, the Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Gurmit S Uppal
- Department of Vitreoretinal Surgery, Moreton Eye Group, Brisbane, Queensland, Australia
| | - Marc Veckeneer
- Department of Vitreoretinal Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Robert M Verdijk
- Department of Vitreoretinal Surgery, the Rotterdam Eye Hospital, Rotterdam, The Netherlands.,Department of Pathology, Section Ophthalmic Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|