Ultrastrukturelle Veränderungen in der Struktur epiretinaler Membranen bei PVR - Anspruch und Wirklichkeit

Zusammenfassung

Hintergrund: Die proliferative Vitreoretinopathie (PVR) ist eine häufige Komplikation der chirurgischen Behandlung von rhegmatogenen Netzhautablösungen. Ziel unserer Untersuchung ist, die ultrastrukturellen Veränderungen in der Struktur epiretinaler Membranen bei PVR zu dokumentieren. Methoden: Innerhalb dieser prospektiven Untersuchung wurden Membranen während der Vitrektomie von 64 PVR-Patienten entnommen. Die wurden später ultrastrukturell im Transmissions- und Rasterelektronenmikroskop analysiert. Ergebnisse: In den frühen Stadien der PVR bestanden die Membranen meistens aus Pigmentepithelzellen (RPE), Fibroblasten und wenigen Glialzellen. In einigen RPE-Zellen haben wir morphologische Veränderungen objektiviert. Bei Patienten mit fortgeschrittener PVR enthielten die Membranen meistens vorwiegend spindelförmige Fibroblasten. Die Zahl der RPE-Zellen war deutlich vermindert. Schlussfolgerung: Unsere Ergebnisse weisen darauf hin, dass epiretinale Membranen nicht stabile, sondern dynamische Strukturen sind, die ständig Zell- und Matrix-Verfassung wechseln können. In Wirklichkeit müssen wir klinische und auch morphologische Veränderungen berücksichtigen, um die bessere therapeutische Behandlung auszuwählen.

Abstract

Background: Proliferative vitreoretinopathy (PVR) is known to be the main cause of failure for routine retinal detachment surgery. Our aim was to document the ultrastructural changes in the epiretinal membranes in cases of PVR. Material and Methods: Epiretinal membranes were taken during vitrectomy of 64 patients with different stages of PVR and further analysed using transmission and scanning electron microscopy. Results: In the early stages of the disease mainly retinal pigment epithelial (RPE) cells, fibroblasts and occasional glial cells were found. Moreover, some of the RPE cells showed altered characteristics. In contrast, epiretinal membranes from the developed stages of PVR were comprised mostly of fibroblasts and a considerably diminished number of RPE cells. Cells with marks of degeneration were generally found. Conclusions: Our results point out that epiretinal membranes in PVR are dynamic structures, constantly changing their cell and matrix composition with the progression of the disease. The morphological changes together with the clinical data are important points to consider when discussing the most appropriate therapeutic approach for each case.

Netzhautablösungen - PVR - Vitrektomie - OCT - Elektronenmikroskop - epiretinale Membranen

Retinal detachment - PVR - vitrectomy - OCT - electron microscopy - epiretinal membranes

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