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Kenneth M. Yee, Billy X. Pan, Fred N. Ross-Cisneros, Edward Chu, Alfredo A. Sadun, J. Sebag; Immunohistochemistry Detects Inner Retina in Excised Membranes from Vitreo-Maculopathies with Poor Post-Operative Vision. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2752.
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Macular pucker (MP) and macular hole (MH) are vitreo-maculopathies that usually respond well to surgery, yet some cases have poor post-operative vision. Tissues obtained at surgery in patients with both good and poor post-operative visual acuity (VA) were analyzed to determine whether visual outcome was associated with certain histologic features. We hypothesized that specimens from cases with poor VA included inner retina adherent to the excised membrane, reflecting deeper planes of dissection.
Twelve surgical specimens (7 MP and 5 MH) from 11 patients (one re-operation) were obtained at vitrectomy. Chromodissection using indocyanine green dye was performed in all primary MH surgeries and in all re-operations. Paraffin and plastic sections were processed for transmission electron microscopy (TEM) and immunohistochemistry (IHC), respectively.
Post-operative VA was good (> 20/60) in 6 cases (1 MH, 5 MP), and poor (≤ 20/100) in 6 cases (4 MH, 2 MP). On TEM, abundant cellular debris was found on the retinal aspect of the internal limiting lamina in 4/5 (80%; 2 MH, 2 MP; one tissue lost during embedding) patients with poor VA, versus 1/6 (16%; MP) patients with good VA (P = 0.036, two-tailed Chi-Squared). Strongly positive neurofilament staining was found by IHC in 4/6 (66.7%; 3 MH, 1 MP) patients with poor VA, versus 0/6 (0%) patients with good VA (P = 0.014).
On TEM analysis, 80% of vitreo-maculopathy cases with poor post-operative VA had cellular debris on the retinal aspect of the tissue removed at surgery. Immunohistochemistry staining for neurofilaments corroborated the ultrastructural findings that this involved rudiments of the nerve fiber layer. Collectively, the data suggest that a deep plane of dissection which includes elements of the inner retina is associated with poor visual outcome.
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