Ultrastructural investigation of the posterior hyaloid membrane in posterior vitreous detachment.

Abstract

Background: Separation of the posterior hyaloid membrane (PHM) from the retina in posterior vitreous detachment (PVD) is a fundamental, but poorly understood, process underlying vitreoretinal disorders including retinal detachment and macular hole. We performed electron microscopy studies of the PHM after PVD to investigate its ultrastructure, associated cellular structures and relationship to the internal limiting membrane (ILM).

Methods: Post-mortem human eyes were collected from recently deceased patients over 70 years of age. A posterior scleral button was trephined to identify PVD status, and the PHM and vitreous prepared for analysis with transmission and scanning electron microscopy.

Results: Twelve eyes from six patients were collected. Seven eyes had PVD; five eyes had attached vitreous. PHM was isolated from seven of seven eyes with PVD. The PHM in eyes with PVD is a laminar lacy sheet, distinct from the disorganised fibres of vitreous gel. Eyes without PVD had vitreous encased in internal limiting membrane which had separated en bloc from the retina. Cells embedded in the PHM (laminocytes) were identified in five of seven eyes with PVD, with strands stretching into the membrane.

Conclusions: PHM isolated from eyes with PVD is distinct from artefactual separation of the ILM from the retina during dissection. PHM is ultrastructurally distinct from vitreous gel and is a separate entity. The en face appearance of PHM is similar to that of ILM, suggesting that in PVD, PHM forms from separation of an inner layer of ILM. Laminocytes may play a role in the pathogenesis of vitreoretinal disease.