Govetto Andrea, Bhavsar Kavita V, Virgili Gianni, Gerber Matthew J, Freund K Bailey, Curcio Christine A, Burgoyne Claude F, Hubschman Jean-Pierre, Sarraf David
Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Portland VA Healthcare System, Portland, Oregon.
Am J Ophthalmol. 2017 Dec;184:167-180. doi: 10.1016/j.ajo.2017.10.011. Epub 2017 Oct 26.
To investigate the tractional alterations of the central bouquet (CB) in idiopathic epiretinal membranes (ERMs).
Retrospective, consecutive, observational case series.
ERMs were classified according to a 4-stage grading system. The CB was defined as a circular area of approximately 100 μm composed of densely packed cones (and Müller cells) in the central fovea. Tractional abnormalities of the CB were identified with spectral-domain optical coherence tomography. Ex vivo histopathologic analysis was performed.
In this study 263 eyes with ERMs were included. Mean follow-up was 21.2 ± 16.7 months. At baseline, tractional abnormalities of the CB were diagnosed in 58 out of 263 eyes (22%) and divided into 3 categories: cotton ball sign (defined as a fuzzy hyperreflective area between the ellipsoid zone and the interdigitation zone in the central fovea), foveolar detachment, and acquired vitelliform lesion. The presence of ectopic inner foveal layers was negatively correlated with the presence of CB tractional abnormalities (P = .002). Visual acuity was highest in association with the cotton ball sign and lowest in the acquired vitelliform lesion group. Sequential morphologic progression was identified in 7 eyes. Ex vivo histopathologic analysis illustrated characteristic staining patterns supporting a potential mechanism of traction by Müller cells in the CB.
The cotton ball sign, foveolar detachment, and acquired vitelliform lesion may comprise a continuum in the same clinical spectrum and may represent subsequent stages of CB abnormalities. Foveal Müller cells may play an integral role in the transmission of mechanical forces to the central foveal cones.
研究特发性视网膜前膜（ERM）中中央视锥束（CB）的牵引性改变。
回顾性、连续性、观察性病例系列研究。
根据4级分级系统对ERM进行分类。CB被定义为中央凹处由密集排列的视锥细胞（和米勒细胞）组成的约100μm的圆形区域。通过光谱域光学相干断层扫描识别CB的牵引异常。进行体外组织病理学分析。
本研究纳入了263只患有ERM的眼睛。平均随访时间为21.2±16.7个月。基线时，263只眼中有58只（22%）诊断出CB牵引异常，分为3类：棉球征（定义为中央凹处椭圆体带和指状交叉带之间的模糊高反射区）、黄斑脱离和获得性卵黄样病变。异位中央凹内层的存在与CB牵引异常的存在呈负相关（P = 0.002）。视力在棉球征组中最高，在获得性卵黄样病变组中最低。在7只眼中发现了连续的形态学进展。体外组织病理学分析显示了特征性染色模式，支持米勒细胞在CB中牵引的潜在机制。
棉球征、黄斑脱离和获得性卵黄样病变可能在同一临床谱中构成一个连续体，可能代表CB异常的后续阶段。中央凹米勒细胞可能在将机械力传递至中央凹视锥细胞中起重要作用。
