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Akira Obana, Hiroyuki Sasano, Yoshiro Otsuki, Takahiko Seto, Yuko Gohto, Shigetoshi Okazaki; The origin and constituents of yellow pigments in the surgically removed epiretinal membrane. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5021.
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© ARVO (1962-2015); The Authors (2016-present)
The surgically removed epiretinal membrane (ERM) in vitreoretinal interface syndrome such as lamellar macular hole (LMH), full-thickness macular hole (FTMH), macular pseudohole (MPH), and idiopathic ERM occasionally contains yellow pigments. These pigments are considered to relate to macular pigments, however there is no proof that the pigments consist of carotenoids, and it is still unclear how macular pigment in the retina is contained in the ERM. We investigated the constituent and origin of the pigments in ERM.
This was an observational case series. Thirty-six eyes of 34 patients (LMH 4 eyes, FTMH 9 eyes, MSH 2 eyes, idiopathic ERM 21 eyes), 16 men and 18 women, were included in the present study. The age was from 41 to 86 years old (mean 67.8, SD 10.7 years old). The removed ERM was observed by resonance Raman microscopy (RRM). The correlation between preoperative OCT findings and presence of yellow pigment in ERM observed under operation microscopy was assessed. Histological observation was performed on the removed specimens. This study was approved by the IRB of Seirei Hamamatsu General Hospital, and all patients signed an informed consent form.
Yellow pigments were observed in 14 eyes (LMH 4 eyes, FTMH 5 eyes, ERM 5 eyes) under operation microscopy. RRM observation was performed in nine of those 14 eyes and carotenoid specific signals (see Figure) were confirmed in five eyes (LMH 3 eyes, FTMH 1 eye, ERM 1 eye). In the 14 eyes, preoperative OCT images revealed thick ERM that was different from typical thin ERM in 11 eyes, and a break in the inner retina in another three eyes. All specimens of ERM with yellow pigments showed positive immunoreactivity for anti-glial fibrillary acidic protein.
Yellow pigments in the surgically removed ERM consist of carotenoids. Yellow pigments were found in cases with the thick ERM. The thick ERM related to LMH was named lamellar hole associated epiretinal membrane and it was reported to originate from Müller cells, although there is still controversy on its origin. On the other hand, Müller cells at the foveal center (Müller cell cone) were considered to have xanthophyll carotenoids. Therefore, we concluded that the yellow pigments in the thick ERM originated from the Müller cell cone, and Müller cells at the foveal center somehow proliferated and formed thick ERM.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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