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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 1053-1056

A clinical study of massive periretinal proliferation (M.P.P.)


Institute of Ophthalmology, Aligarh Muslim University, Aligarh, India

Correspondence Address:
Manoj Shukla
Institute of Ophthalmology, Aligarh Muslim University, Aligarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 6544257

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How to cite this article:
Shukla M, Ahuja O P, Chaturvedi J. A clinical study of massive periretinal proliferation (M.P.P.). Indian J Ophthalmol 1983;31, Suppl S1:1053-6

How to cite this URL:
Shukla M, Ahuja O P, Chaturvedi J. A clinical study of massive periretinal proliferation (M.P.P.). Indian J Ophthalmol [serial online] 1983 [cited 2020 May 27];31, Suppl S1:1053-6. Available from: http://www.ijo.in/text.asp?1983/31/7/1053/29745

Table 5

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Table 5

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Table 4

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Table 3

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Table 3

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Table 2

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Table 2

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Table 1

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Table 1

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Massive periretinal proliferation (M.P.P.) is a serious complication of rhegmatogenous retinal detachment. The condition usually culminates in blindness as surgical results are invariably very poor. This report highlights some of the important clinical features of retinal detachment complicated by massive periretinal proliferation.


  Material and methods Top


73 consecutive cases of rhegmatogenous retinal detachment with massive periretinal proliferation in one eye which were seen at our center between 1978 to 1981 are analysed in the present study. 52 eyes were phakic, while the rest were aphakic. After a routine recording of visual acuity and refractive status, the retina was examined, after full dilatation of pupils, by an indirect ophthal­moscope and scleral depressor. This was further supplemented by posterior segment biomicroscopy with the help of a Goldmann's 3-mirror contact lens. A special attention was paid to the study of vitreous morphology and movements, presence of cellular and pigmen­ted opacities and posterior vitreous deta­chment during three mirror examination.

The findings were recorded on a standard fundus topography chart.


  Observations Top


Massive periretinal proliferation was graded into four grades depending upon the clinical appearance of retina and vitreous [Table - 1]. While the earliest changes included restriction in the movements of vitreous along with multiple pigment particles in vitreous, the advanced M.P.P. was seen in the form of fixed star shaped retinal folds with a dep­ressed center, and funnel shaped retinal detachment with gross shrinkage of vitreous. Out of 33 eyes having retinal detachment of more than six months duration, 18 (54.55%) had mild (grade I-I1) M.P.P. while on the other hand 15 (37.50%) out of 40 eyes having retinal detachment of less than six months duration had advanced (grade III-IV) pro­liferative changes. Interestingly, 7 (36.84%) out of 19 eyes having retinal detachment of less than one month duration had advanced M.P.P. [Table - 2].

Age and Sex

Massive periretinal proliferation was seen in all the age groups, although max­imum incidence was seen in fifth decade of life (Talbe 3). Males were affected two and a half times more than females (P*(.001).

Visual Acuity

Visual acuity was invariably very poor in most of the eyes. However, 3 out of 73 eyes had a visual acuity of 6/60 as macula was unaffected.

Extent of Detachment

In all but three eyes, the detachment was total involving macular area. The detach­ment was typically bullous in 38 (52.05%) eyes.

Retinal Breaks

A total of 69 retinal breaks were seen in. 45 (61.64%) eyes with an average of 1.53 break per eye, while in the remaining 28 (38.36%) eyes with advanced M.P.P. no retinal break could be localised even after repeated examinations. Horse shoe tears followed by round holes were the com­monest eype of retinal break seen in the affected eyes [Table - 4]. Large dialysis and giant tears were invariably associated with advanced M.P.P. lattice degeneration with round holes was responsible for M.P.P. in 4 (5.48%) eyes.

Vitreous Morphology

Vitreous movements were slightly res­tricted in 25 eyes, while in the rest they were markedly restricted with gross shrinkage of vitreous. In all the affected eyes, vitreous was interspersed with multiple pigmented particles which were more densely seen in the inferior part of vitreous.


  Discussion Top


In recent years number of workers have described the development of preretinal membrane in retinal detachment. This has been variously called as massive vitreous retraction - M.V.R.[1],[2] massive Preretinal retraction - M.P.R[3] Massive preretinal fibroplasia [4] and massive periretinal pro­liferation [5],[6],[7]. Nearly all of them agree that development of preretinal membrane in rhegmatogenous retinal detachment is a very bad prognostic sign and is responsible for majority of retinal surgical failures.

Tolentino, Schepens and freeman (3) des­cribed the biomicroscopic appearance of massive preretinal retraction in 54 eyes. They observed extreme syneresis with shrinkage of vitreous cortex in all the affected eyes. According to them, the shrinking vitreous gel drags the detached retina forward, producing a funnel shaped detachment. In this study, the earliest sign of M.P.P. observed was early res­triction in the movement of vitreous. In our opinion, restriction of vitreous movement alongwith the presence of pigment particles is the earliest sign of M.P.P., and should always be looked for in the early detection of this condition. Pigmented particles in an­terior vitreous in the absence of previous ocular surgery or trauma is almost a pa­thognomonic sign of a retinal breaks. Machemer and Laqua[5] in a study of ex­perimental retinal detachment in owl mon­key demonstrated that pigment epithelial macrophages are responsible for epiretinal and subretinal membrane formation. Fur­ther, metaplastic pigment epithelial cells can produce collagen[5],[9] which may be the factor responsible for contraction of these mem­branes. Cytoplasmic filaments have been demonstratedin metaplastic pigment epithe­lial cells and proliferating glial cells, and are believed to take an active part in the contrac­tion of these cells[5],[6],[10]. sub It is a common observation that all eyes with pigment particles or tobacco dust in vitreous do not develop M.P.P. It is thus possible that the number and density of pigment cells reaching vitreous throught the retinal break may be the decid­ing factor as M.P.P. is quite frequently seen with large tears, dialysis and giant tears which naturally would allow a greather numberof pigmented macrophages in the vitreous cavi­ty. This is further substantiated by the fact that M.P.P. develops quite often after application of diathermy or cryopexy in the management of giant tear.

The full blown picture of M.P.P. is the for­mation of fixed radial, cicular or star shaped folds[3],[7]. The formation of fixed folds lead to disorganisation of retina and may explain the failure in localizing the retinal break. The dis­tribution of retinal breaks in retinal detach­ment complicated by M.P.P. is the same as in a simple rhegmatogenous retinal detachment[11] Tolentino, Schepens and Freeman[3] found lattice degeneration in 40% of eyes with M.P.P. while we observed it in only 5.48% eyes.

An interesting observation of the present study was that the duration of retinal detach­ment had no bearing on the development of M.P.P. While advanced M.P.P. may be pre­sent in retinal detachment of recent onset, milder forms are frequently seen in long­standing retinal detachment. [Table - 2]. It is thus extremely necessary to detect this condi­tion in its earliest evolution by careful biomic­roscopic study of retina and vitreous. Surgical prognosis consequently would be much bet­ter in early M.P.P. than in an advanced M.P.P. with star shaped folds or funnel detachment where surgical results are invariably poor.


  Summary Top


Massive periretinal proliferation is a serious complication of rhegmatogenous retinl detachment. In the earler stage it is seen as pigmented opacities in the vitreous with decrease in vitreous movements while advan­ced stages are characterized by fixed star shaped folds. The condition is most frequen­tly seen in extensive detachment with large breaks and has no relation with duration of retinal detachment. Early detection of this condition has a favourable surgical prognosis.

 
  References Top

1.
Havener, W.H., 1973, Ophthalmic Surgery, 4:22.  Back to cited text no. 1
    
2.
Scott, J.D., 1976, Trans. Ophthalmol. Soc. UK 45:429.  Back to cited text no. 2
    
3.
Tolentino, F.I., Schepens, C.L., and Freeman, H.M., 1967, Arch. Opthtalmol. 78:16.  Back to cited text no. 3
    
4.
Cibis, P., 1975, Vitreoretinal pathology and surgery in retinal detachment. St. Louis, C.V. Mosby.  Back to cited text no. 4
    
5.
Machemer, R, and Laqua, H., 1975, Aner. J. Ophthalmol. 80:1.  Back to cited text no. 5
    
6.
Laqua, H., and Machemer, R., 1975, Amer. J. Ophthalmol. 80:913.  Back to cited text no. 6
    
7.
Machemer, R, 1977, Trans. Amer. Ophthalmol. Soc. 55:556.  Back to cited text no. 7
    
8.
Hamilton, A.M. and Taylor, W., 1972, Brit. J. Ophthalmol. 56:700.  Back to cited text no. 8
    
9.
Muller - Jensen, K, Machemer, R., and Azarnia, R, 1975, Amer. J. Ophthalmol. 80:530.  Back to cited text no. 9
    
10.
Spoons, B.S., Yamada, KM., and Wessels, N.K, 1971, J. cell biol. 49:595.  Back to cited text no. 10
    
11.
Ahuja, O.P., Shukla, M., and Bajaj, R.P.,1980, Proc. XXXIX All India Ophthalmological conference (in press).  Back to cited text no. 11
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]



 

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