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The role of Müller cells in tractional macular disorders: an optical coherence tomography study and physical model of mechanical force transmission.

  • Author(s): Govetto, Andrea
  • Hubschman, Jean-Pierre
  • Sarraf, David
  • Figueroa, Marta S
  • Bottoni, Ferdinando
  • dell'Omo, Roberto
  • Curcio, Christine A
  • Seidenari, Patrizio
  • Delledonne, Giulia
  • Gunzenhauser, Robert
  • Ferrara, Mariantonia
  • Au, Adrian
  • Virgili, Gianni
  • Scialdone, Antonio
  • Repetto, Rodolfo
  • Romano, Mario R
  • et al.
Abstract

Background

To explore the role of foveal and parafoveal Müller cells in the morphology and pathophysiology of tractional macular disorders with a mathematical model of mechanical force transmission.

Methods

In this retrospective observational study, spectral-domain optical coherence tomography images of tractional lamellar macular holes and patients with myopic foveoschisis were reviewed and analysed with a mathematical model of force transmission. Parafoveal z-shaped Müller cells were modelled as a structure composed of three rigid rods, named R1, R2 and R3. The angle formed between the rods was referred to as θ . R1, R2 and R3 lengths as well as the variation of the angle θ were measured and correlated with best corrected visual acuity (BCVA).

Results

In tractional lamellar macular holes, there was a significant reduction of the angle θ towards the foveal centre (p<0.001). By contrast, there were no significant differences in θ in myopic foveoschisis (p=0.570). R2 segments were more vertical in myopic foveoschisis. There was a significant association between lower θ angles at 200 µm temporal and nasal to the fovea and lower BCVA (p<0.001 and p=0.005, respectively). The stiffness of parafoveal Müller cells was predicted to be function of the angle θ , and it grew very rapidly as the θ decreased.

Conclusion

Parafoveal Müller cells in the Henle fibre layer may guarantee structural stability of the parafovea by increasing retinal compliance and resistance to mechanical stress. Small values of the angle θ were related to worse BCVA possibly due to damage to Müller cell processes and photoreceptor's axons.

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