En face optical coherence tomography of foveal microstructure in full-thickness macular hole: a model to study perifoveal Müller cells

Am J Ophthalmol. 2015 Jun;159(6):1142-1151.e3. doi: 10.1016/j.ajo.2015.02.013. Epub 2015 Feb 26.


Purpose: To characterize perifoveal intraretinal cavities observed around full-thickness macular holes (MH) using en face optical coherence tomography and to establish correlations with histology of human and primate maculae.

Design: Retrospective nonconsecutive observational case series.

Methods: Macular en face scans of 8 patients with MH were analyzed to quantify the areas of hyporeflective spaces, and were compared with macular flat mounts and sections from 1 normal human donor eye and 2 normal primate eyes (Macaca fascicularis). Immunohistochemistry was used to study the distribution of glutamine synthetase, expressed by Müller cells, and zonula occludens-1, a tight-junction protein.

Results: The mean area of hyporeflective spaces was lower in the inner nuclear layer (INL) than in the complex formed by the outer plexiform (OPL) and the Henle fiber layers (HFL): 5.0 × 10(-3) mm(2) vs 15.9 × 10(-3) mm(2), respectively (P < .0001, Kruskal-Wallis test). In the OPL and HFL, cavities were elongated with a stellate pattern, whereas in the INL they were rounded and formed vertical cylinders. Immunohistochemistry confirmed that Müller cells followed a radial distribution around the fovea in the frontal plane and a "Z-shaped" course in the axial plane, running obliquely in the OPL and HFL and vertically in the inner layers. In addition, zonula occludens-1 co-localized with Müller cells within the complex of OPL and HFL, indicating junctions in between Müller cells and cone axons.

Conclusion: The dual profile of cavities around MHs correlates with Müller cell morphology and is consistent with the hypothesis of intra- or extracellular fluid accumulation along these cells.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Animals
  • Cysts / diagnosis*
  • Disease Models, Animal
  • Ependymoglial Cells / metabolism
  • Ependymoglial Cells / pathology*
  • Female
  • Fovea Centralis / pathology*
  • Glutamate-Ammonia Ligase / metabolism
  • Humans
  • Immunohistochemistry
  • Macaca fascicularis
  • Male
  • Microscopy, Fluorescence
  • Middle Aged
  • Retinal Diseases / diagnosis*
  • Retinal Perforations / diagnosis*
  • Retrospective Studies
  • Subretinal Fluid
  • Tissue Donors
  • Tomography, Optical Coherence*
  • Zonula Occludens-1 Protein / metabolism


  • Zonula Occludens-1 Protein
  • Glutamate-Ammonia Ligase