Long-term changes in photocoagulation burns

101 argon laser and xenon arc photocoagulation burns were studied clinically and histopathologically in 8 diabetics patients treated for PDR. The age of the lesions ranged between 4 and 70 months. Our observations confirmed long-term patterns of retinal pair observed previously only in animals. Moderately severe burns, when placed in the thick paracentral retina, at times resulted in differentiated retinal repair not associated with new retinal adhesions. Severe burns created full thickness retinal defects, but spared the inner limiting membrane and allowed formation of apparently firm new retinal adhesions. These burns are considered as most suitable for the scatter treatment of PDR. Very severe burns exhausted the retinal capacity for glial repair so that the RPE became the only resource of retinal reparative tissue. In such scars the RPE bordered the vitreoretinal juncture yet did not invade the vitreous. However, glial preretinal membranes were frequently seen over very severe burns exerting tangential retinal traction.

Transgenic mice with pigmented intraocular tumors: tissue of origin and treatment

PURPOSE

To describe the cell of origin, tumor progression, light and electron microscopic appearance, immunohistochemical properties, and response to frequently used anticancer therapies in two transgenic models of intraocular melanoma.

METHODS

Two lines of transgenic mice that develop pigmented intraocular tumors were produced with the SV40 T and t antigens under the control of the mouse tyrosinase gene. Tumors were sequentially studied and characterized by light microscopy, electron microscopy, and immunohistochemistry stains. Tumor response to two cycles of dacarbazine was assessed on the basis of tumor size in one group of animals. Response to external beam irradiation was measured by survival time in other animals.

RESULTS

Two lines of transgenic mice developed bilateral intraocular tumors with complete penetrance and without primary cutaneous melanomas. Tumors developed first in the retinal pigment epithelial layer, with subsequent retinal and choroidal invasion, extraocular extension, and metastasis. Tumors stained positive for S-100, HMB-45, and Fas-ligand. Electron microscopy revealed polarization of tumor cells with basement membrane formation, microvilli, immature melanosomes, and abundant endoplasmic reticulum. Dacarbazine significantly reduced tumor size in these mice, and a trend toward dose-dependent decrease in survival was found with external beam irradiation.

CONCLUSIONS

Tumors developed from the retinal pigment epithelium. Their histology and growth, however, closely resembled that of human choroidal melanoma. This model may be a useful tool for future studies of endogenous primary pigmented tumors limited to the eye. Response to standard therapies suggests it can serve as a model with which to evaluate therapeutic modalities.

Superior cervical ganglionectomy in monkeys: light and electron microscopy of the anterior eye segment

Morphological changes in the anterior eye segment of eight cynomolgus monkeys were investigated 2 days to 2.2 years after unilateral surgical superior cervical ganglionectomy (SCGx). SCGx was confirmed by histologic examination of the excised surgical specimen and persistent ipsilateral miosis. In four short-term monkeys (2, 4, 7 and 11 days), iris, ciliary muscle and trabecular meshwork were studied by electron microscopy. In the other four longer-term monkeys (3 week, 4 week, 5 week, 2.2 year) the anterior eye segment was investigated with tyrosine hydroxylase immunohistochemistry (TH-IR) and catecholamine fluorescence (CF). Electron microscopy of experimental eyes showed characteristic signs of Wallerian degeneration in numerous nerve fibers and terminals in the iris, but to a lesser extent in the ciliary muscle and the trabecular meshwork. TH-IR and CF showed marked interindividual differences. In all experimental eyes, there was a marked reduction, but never a complete absence of adrenergic nerves in the iris. In two animals (4 week and 2.2 years), the adrenergic innervation of the ciliary body and the chamber angle was similarly reduced. In contrast, in the experimental eyes of the other two animals (3 and 5 weeks), changes in adrenergic innervation to the ciliary body and chamber angle were minimal or absent. The results indicate that following apparently complete SCGx in the cynomolgus monkey, reduction of adrenergic innervation to the iris as evidenced by pupillary physiology, electron microscopy, TH-IR and CF does not guarantee reduction in adrenergic innervation to the ciliary body and trabecular meshwork. SCGx may not extirpate all third order sympathetic neurons in the distal stump, or there may be a significant contribution of accessory ganglion cells to the adrenergic innervation of the anterior eye segment.

The color of the human eye: a review of morphologic correlates and of some conditions that affect iridial pigmentation

Iris color can be affected by a variety of ocular disorders. It is suspected that iris color may not remain constant throughout life. These observations have drawn attention to the morphologic correlates of iris color and its regulation. Differences in the iris color of normal eyes are the result of variable amounts of melanin pigment granules within a constant number of melanocytes in the superficial stroma of the iris. These melanocytes seem to reach their genetically determined amount of melanin in early childhood, and their melanin content usually remains constant in adulthood. Diseases such as Horner's syndrome and Fuchs' heterochromic iridocyclitis affect iris color, resulting in a decrease of iris pigmentation. Evidence suggests that melanin content of some melanocytes is subject to adrenergic regulation even past childhood. Application of the prostaglandin analogue latanoprost, on the other hand, leads to an increase in iris pigmentation in some patients. Studies with cultured dermal and uveal melanocytes, as well as with uveal melanoma cells, however, show no increase in cell proliferation when treated with latanoprost in vitro. The mechanisms by which latanoprost affects regulation of iris pigmentation requires further investigation.

Clinicopathologic correlation of intraretinal microvascular abnormalities

PURPOSE

To define the cross-sectional morphology of intraretinal microvascular abnormalities, which previously have been described only in terms of trypsin digestion.

MATERIAL/METHODS

Fourteen vascular lesions of five patients with diabetic retinopathy were identified on fundus photographs and/or fluorescein angiograms and classified as intraretinal microvascular abnormalities. Eyes of these patients were obtained after the patients' deaths. The period between the time at which the photographs were taken and that at which enucleation was performed was 3-20 months. The duration of autolysis before fixation was 5 hours or less. The embedded tissue was evaluated by light and electron microscopy, and these findings were correlated with the clinical appearance.

RESULTS

The lesions consisted of multiple, closely spaced, thin-walled vascular lumina with a caliber of 20-70 microns. They were located in the inner retina and surrounded by a wide cuff containing randomly oriented collagen fibers. Endothelial cell nuclei were numerous. Pericyte degeneration and multiplication of the endothelial and pericyte basement membrane had occurred. Endothelial junctions were short, and gaping of junctions was not seen. However, occasional fenestrations were present.

CONCLUSION

The cross-sectional morphology of intraretinal microvascular abnormalities is consistent with vascular pathology typical for intraretinal diabetic microangiopathy, but also includes features usually seen in new vessels. This supports the concept that intraretinal microvascular abnormalities have the particular potential for neovascularization.

Melanocytes and iris color. Light microscopic findings

OBJECTIVE

To systematically evaluate morphologic differences in iris stroma that contribute to clinically perceptible differences in iris color, using immunohistochemical identification of stromal melanocytes and fluorescence microscopy.

METHODS

Paraffin-embedded sections from 51 human irides were stained with S100a and fluorescein isothiocyanate. Cells were counted and scored as melanocytes or other. Melanocyte number, proportion, and density were determined for light-colored (blue), medium-colored (hazel) and dark-colored (brown) irides and compared.

RESULTS

No statistically significant difference was observed for mean total cellularity or mean melanocyte number among the three color groups. Mean total stromal cell count was 1177 +/- 259 (mean +/- SEM), and mean melanocyte number was 778 +/- 196 per 5-micrometer section. In human irides, 65.9% of the iris stroma is composed of melanocytes. Melanocyte density (number of cells per square millimeter) is not related to iris color.

CONCLUSION

The number of melanocytes, the proportion of melanocytes, and iris stromal cellularity are not major contributors to iris color.

Melanocytes and iris color. Electron microscopic findings

OBJECTIVE

To quantitatively associate iris color with melanocyte pigment content.

METHODS

Autopsy eyes were classified as uniform-blue, uniform-hazel, or uniform-brown or showing a darker peripupillary ring. Using electron microscopic images and computerized image analysis, area, number, and size of mature melanosomes within the perinuclear cytoplasmic area only or within perinuclear and peripheral cytoplasmic areas of the superficial stromal melanocytes combined were measured.

RESULTS

Average melanosomal area per perinuclear cytoplasmic area (AMAC) and average number of melanosomes per perinuclear area (AMNC) significantly differed across iris color groups (overall P<.001). This result reflects the large difference between blue-uniform and all other color groups. A marginally significant (nominal) trend from blue-ring through brown-ring was also detected (P=.06 for AMAC and P=.07 for AMNC). The average perinuclear cytoplasmic area was larger in the central iris zone (within 1 mm around the pupillary margin) than in the intermediate iris zone (between 1 and 2 mm around the pupillary margin) (P=.002), but AMAC and AMNC did not significantly differ between zones. The average melanosome size did not differ significantly across color groups (P=.11).

CONCLUSION

Differences in iris colors are at least partially attributed to variable AMNC and AMAC within superficial melanocytes.

Renin mRNA is synthesized locally in rat ocular tissues

Components of the Renin Angiotensin System (RAS) have been detected in ocular tissues and fluids. The source of the ocular RAS proteins is unknown but possibilities include diffusion or leakage from the systemic circulation, specific uptake from the blood, or local synthesis. We have used RT-PCR and in situ hybridization (ISH) to show that renin mRNA is present in ocular tissues from 3 strains of rats. By RT-PCR, we found 10 of 15 ciliary body samples, 13 of 16 iris samples, and 1 of 3 retina samples were positive for renin mRNA. Also, 6 of 6 brain and 7 of 8 kidney samples were positive. Using ISH, we found renin mRNA in the ciliary muscle adjacent to the sclera extending into the choroid. Tissue near the outflow channels of the anterior chamber angle also labeled. Retinal labeling was weak but present in the nerve fiber layer. Clusters of grains, possibly representing blood vessels, were also seen in the ciliary body, iris, and retina using ISH. These results suggest the presence of a local ocular RAS.

Ocular renin angiotensin: EM immunocytochemical localization of prorenin

Prorenin (PR) was localized by electron microscopic (EM) immunostaining of cryo-ultramicrotomy sections of human ciliary body and correlated with light microscopic immunostaining. Both layers of the ciliary epithelium contained the prohormone. However, density was much higher in the adjacent extracellular spaces, particularly in the vitreous cortex. This observation adds further evidence to a role of the ciliary epithelium in the transfer, storage or synthesis of components of a putative ocular renin angiotensin system.

Sub-pigment epithelial membranes after photocoagulation for diabetic macular edema

OBJECTIVE

The chronic histopathologic effects of focal and grid argon laser photocoagulation were examined in eyes obtained at autopsy that had previously been treated for diabetic macular edema. The focus was on further characterizing fibrous sub-pigment epithelial membranes that previously had been shown to extend beyond burn edges.

DESIGN

A total of 131 argon laser burns were evaluated in five eyes. Tissue was embedded in paraffin or glycol methacrylate, serially sectioned, and examined by light microscopy.

MAIN OUTCOME MEASURE

Outer and inner nuclear layer defects were measured, and the frequency and extent of sub-pigment epithelial membranes was estimated. The presence of Müller cell processes among membranes was evaluated by immunostaining for glial fibrillary acidic protein and enzyme histochemical staining for carbonic anhydrase.

RESULTS

Burns consistently produced defects in the outer nuclear layer that were larger than the spot size of the laser beam. Inner nuclear layer defects were present in only seven of 131 burns. Glycol methacrylate--embedded tissue sections from 73 burns showed sub-pigment epithelial membranes in all five eyes. In one eye, membranes were confluent between burns. In the remaining four eyes, 37 individual membranes were found among 53 burns, and 47% of membranes contained Müller cell processes. The membranes in paraffin-embedded tissue could not be adequately evaluated.

CONCLUSIONS

After focal laser treatment for diabetic macular edema, the inner retina was usually spared. Fibrous sub-pigment epithelial membranes were frequent among burns in all five eyes, and they showed a conspicuous contribution by Müller cell processes. We speculate that by impairing the overlying pigment epithelium, these membranes may contribute to a progressive enlargement of laser scars.

Levator aponeurosis elastic fiber network

This light and electron microscopic study demonstrates an elastic fiber network (EFN) for the levator palpebrae superioris muscle complex, which forms an intricate insertion into the upper eyelid. The EFN is examined in the monkey, in a fresh exenteration specimen, and in fresh frozen cadaver specimens from both sexes of different age groups. Multiple elastic insertions of the levator aponeurosis and Muller's muscle attachment with well-organized elastic fibers are demonstrated using special staining techniques and serial microscopic sectioning. Transmission electron microscopy (TEM) confirms the ultrastructure of "mature" elastin fibers in Muller's muscle tendon and their close relationship with the elastin-related fiber, oxytalan. Current thinking concerning the nature of elastic fibers and their possible implications in acquired involutional blepharoptosis is discussed. This microscopic study of the EFN of the upper eyelid focuses attention on the multiple elastic fiber insertions of the levator muscle complex that includes the levator aponeurosis, the conjoined fascia, the lid crease area, and Muller's muscle tendon, which have not been previously described.

Systemic hypertension produces pericyte changes in retinal capillaries

PURPOSE

The purpose of this study was to examine retinal capillaries and their pericytes that previous research suggests to be contractile. A contractile role regulating capillary blood flow may be more apparent when the vasculature is subjected to the stress of systemic hypertension.

METHODS

Using ultrastructural morphometry and the myosin subfragment-1 technique, retinal capillaries of normal and hypertensive rats were measured at three different time points, early, intermediate, and late (24, 44, and 68 wk).

RESULTS

Hypertensive capillaries seemed to dilate at the early time point (P = 0.002), were constricted at the intermediate time point (P < 0.001), and did not redilate later. Wall thickness was enlarged at all times, pericyte coverage (the ratio of plasma membrane length in contact with the vascular circumference to the outer circumference of the endothelial tube) was greater at early and intermediate time points, and the total area of viable cytoplasm relative to the vessel wall area was increased at the intermediate time (all P < 0.001). Also, at the intermediate time, the circumferential coverage of the endothelial tube by actin filament bundles within pericytes and the actin area relative to the vessel wall area had increased (P < 0.001).

CONCLUSIONS

These data indicate that the effects of systemic hypertension extend into the retinal capillary bed, causing pericyte change with actin increase and capillary constriction. They represent the first in vivo indirect evidence by morphologic criteria for pericyte contractility in retinal vascular disease.

An ocular renin-angiotensin system. Immunohistochemistry of angiotensinogen

The circulating renin-angiotensin system (RAS) is an important determinant in maintaining adequate systemic blood pressure, and it also may modify organ-specific blood flow. All recognized RAS components have been identified in the eye. In this study, angiotensinogen (ANG) was localized using an affinity-purified antibody and paraffin sections of seven human eyes. An antibody for human serum albumin was used for comparison. The ANG was present selectively in the cytoplasm of the nonpigmented ciliary epithelium (NPCE), more prominently in the pars plana than in the pars plicata. Both ANG and albumin were present in the blood vessel lumina of the uvea and retina. Both antibodies also stained perivascular tissue in the uvea, but not in the retina, reflecting the relative tightness of blood-tissue barriers. The detection of ANG in the NPCE may be significant in view of previous descriptions localizing prorenin and angiotensin-converting enzyme in the same cell layer.

Sympathetic Nerve Anatomy in the Cavernous Sinus and Retrobulbar Orbit of the Cynomolgus Monkey

We present new information regarding the sympathetic nerve anatomy in the cavernous sinus and retrobulbar orbit of the cynomolgus monkey. Postganglionic sympathetic nerves were identified using an immunoperoxidase technique in which the primary antiserum was directed against tyrosine hydroxylase, the rate-limiting enzyme in norepinephrine synthesis. Our work is unique in adapting this staining method to paraffin-embedded tissue. This technique allows sympathetic nerve fibers to be distinguished from other autonomic, sensory, and motor nerves. A large sympathetic nerve bundle lateral to the internal carotid artery in the cavernous sinus gave off one or more branches that leave the artery to encircle the abducens nerve. Further division occurs within the cavernous sinus, but all sympathetic nerve fibers destined for the orbit entered it through the superior orbital fissure. None pass through the optic canal. In the orbit, sympathetics were associated with the ophthalmic artery and some of its branches and with the sensory root to the ciliary ganglion. After entering the ganglion, the sympathetic fibers were lost to detection in most specimens, but they were again seen in a single short ciliary nerve in one instance. Sympathetic nerve fibers were not detected adjacent to several structures identified in the human anatomy literature, such as the intracranial and intracanalicular segments of the ophthalmic artery, the nasociliary nerve, the long ciliary nerves, the nerve to the inferior oblique muscle, or the lacrimal artery and nerve.

Clinicopathologic correlation of diode laser burns in monkeys

One hundred twenty-five retinochoroidal photocoagulation burns, produced by a transpupillary diode laser (810 nm) in six eyes of three cynomolgus monkeys, were evaluated by clinicopathologic correlation for up to 9 weeks after laser treatment. Diode burns of clinical grade 2 strength were comparable to those described for argon laser. However, diode burns of clinical grade 3 strength produced choroidal changes more intense than those described for argon laser. Where present underneath photocoagulation sites, ciliary nerves in choroid or sclera consistently showed scarring. Prospective randomized controlled clinical trials to document possible clinical equivalence or superiority of diode treatment have not yet been performed. Potential clinical advantages of the diode laser include its weight, size, durability, price, absence of visible flash, and its ability to produce burns that profoundly affect the choroid.

Parasympathetic denervation of the ciliary muscle following panretinal photocoagulation

Cynomolgus monkeys underwent unilateral panretinal scatter photocoagulation (PRP) and/or nasal and temporal horizontal retinal meridional photocoagulation (HRMP) with xenon arc or argon or krypton laser light. Shortly thereafter, in the PRP-treated eyes, accommodative responsiveness to topical eserine and electrical stimulation of the Edinger-Westphal nucleus (EWN) was diminished, accommodative responsiveness to intramuscular (i.m.) pilocarpine was enhanced, and the number of muscarinic receptors in the ciliary muscle was reduced compared to the contralateral controls. In most instances, these parameters returned to normal over 6-12 wks and the abnormalities could be induced again by another round of PRP. However, in some PRP-treated eyes, accommodative responsiveness to EWN stimulation and topical eserine remained subnormal permanently (greater than 1 yr). Shortly after HRMP alone, accommodative responses to i.m. pilocarpine, topical eserine, and central stimulation did not differ markedly in the treated and control eyes. Morphologic studies 1 to 78 wk following PRP revealed that myelinated and unmyelinated nerves within the entire circumference of the choroid and ciliary muscle were severely damaged early on. The number of unmyelinated nerves between the individual ciliary muscle fibers was drastically reduced, those which remained were swollen or deteriorated, and agranular synaptic vesicles were rarely seen. Thereafter, the nerves in the choroid and ciliary muscle gradually regenerated. Following HRMP, only the choroidal nerves which passed through the photocoagulated areas and the ciliary muscle nerves in the corresponding meridians showed signs of deterioration, and there was minimal effect on the physiologic responses examined. These findings collectively indicate that intraocular parasympathetic denervation of the ciliary muscle is produced by PRP, although all nerve types are likely damaged.

Pericyte changes in branch retinal vein occlusion

The model of experimental branch vein occlusion (BVO) in the monkey offers the opportunity to examine retinal capillaries under stress. Electron microscopic morphometry was done on 812 capillaries of 13 eyes of cynomolgus monkeys, comparing 579 capillary collaterals of 9 BVO eyes with 233 normal capillaries of 4 control eyes. The tissue underwent the myosin subfragment-1 technique to decorate and quantify bundles of actin filaments in capillary pericytes. The duration of BVO was 2-48 months. Capillary collaterals of BVO eyes had an enlarged caliber, endothelial hyperplasia, and pericyte hypertrophy, but no proportional increase in basement membrane area. Collaterals near the inner plexiform layer (IPL) had a greater wall thickness, pericyte coverage, and actin coverage than collaterals near the outer plexiform layer (OPL). Pericyte hypertrophy was proportionate to caliber increase in OPL vessels and exceeded caliber increase only in IPL vessels. Actin coverage was proportional with the vessel dilation and size of pericyte cytoplasm in all vessels. These findings indicate that capillary collaterals in BVO are not equipped morphologically for an increased regulatory role in microvascular flow beyond their normal function.

Immunostaining of preretinal membranes for actin, fibronectin, and glial fibrillary acidic protein

The frequency and extent of immunostaining for actin, fibronectin (FN), and glial fibrillary acidic protein (GFAP) were determined in 37 preretinal membranes (PRMs) obtained at vitrectomy from 35 patients with proliferative diabetic retinopathy (PDR) (n = 16), proliferative vitreoretinopathy (PVR) (n = 18), or idiopathic macular pucker (MP) (n = 3). All three proteins were detected in the vast majority of specimens (actin, 86%; FN, 95%; GFAP, 96%), although the extent of staining varied for each. Actin-FN co-localization was observed in all diagnostic groups on comparison of adjacent sections and in double-labeled sections. The extent of actin staining did not correlate with clinical grading of PRM contraction. In PDR membranes, FN staining was low overall, but proportional to the vascular content of the PRM. Fibronectin staining of PVR membranes was greater, and extensive even in avascular specimens. In MP membranes, most cells were GFAP-positive, whereas in PDR and PVR specimens, GFAP staining was variable. The lack of correlation of clinical contractility and membrane composition, as studied in this article by immunostaining, indicates that other factors must play significant roles in determining membrane behavior.

Ocular renin-angiotensin: immunohistochemical evidence for the presence of prorenin in eye tissue

Angiotensin II (A2) is a vasoconstrictor generated by the renin-angiotensin system. A2 appears to act also as an angiogenic factor. Recent evidence suggests that renin is synthesized at many tissue sites and may generate A2 locally. Local A2 may have important functions in the normal and diseased eye. We examined eight human eyes by immunostaining with an antibody to prorenin, the biosynthetic precursor of renin. In all eyes, prorenin staining was extensive in the pars plicata of the ciliary body suggesting that the ciliary body synthesizes renin and this renin may be part of an ocular A2 generating system.

Cystoid macular degeneration in experimental branch retinal vein occlusion

Macular edema and collateral vessels were examined clinically and histopathologically up to 48 months after branch retinal vein occlusion in six eyes of five cynomolgus monkeys. In all six, central macular swelling and fluorescein leakage from the retinal vasculature were confined to the acute stage. However, histopathologically, at the chronic stage, only two maculas were completely recovered and unremarkable, whereas the other four showed variable degrees of cystoid degeneration and photoreceptor cell loss. In the two recovered maculas, six to eight normal-sized capillaries separated the fovea from the nearest cluster of capillary collaterals. In three maculas with cystic degeneration, collaterals incorporated the circumfoveal capillaries. In the fourth macula with cystic degeneration, collaterals were separated from the center by two normal-sized capillaries but were also associated with large areas of capillary nonperfusion partially due to occlusion of the macular arteriole.

The development of vitreous membranes and retinal detachment induced by intravitreal carbon microparticles

We induced intravitreal cellular proliferation by injection of carbon microparticles (size 20-70 nm) into the vitreous of 21 eyes of 11 cynomolgus monkeys. Pathological changes were evaluated by light and electron microscopy. At 1 week, there was conspicuous cyclitis showing exudative separation of the nonpigmented and pigmented ciliary epithelium, inflammatory cells, mononuclear phagocytes, and premacular vitreous detachment. At 3 weeks, continued macrophagic response was accompanied by fibrovascular proliferation with ingrowth of vessels from the ciliary body into the vitreous. At 4-5 weeks, deposition of extracellular fibrous material and traction retinal detachment (RD) were found. At 10 weeks, all eyes had extensive RD with pre- and subretinal collagenous cellular membranes. Carbon-laden macrophages were aggregated over the optic disc and fovea with prepapillary neovascularization and cystoid macular edema. Thus, intravitreal fibrovascular proliferation, vitreous contraction, and RD were induced by inflammatory and phagocytic response to carbon particles.

Focal photocoagulation of diabetic macular edema. A clinicopathologic case report

This is the first reported clinicopathologic correlation of focal photocoagulation treatment in a diabetic patient treated as part of the Early Treatment of Diabetic Retinopathy Study (ETDRS). Twenty focal argon laser burns were evaluated clinically in their acute and chronic stages, and histopathologically more than 3 years after exposure. Damage profiles of the lesions were reconstructed from serial tissue sections. In single burns the outer nuclear layer defect measured 78 +/- 31 microns, in confluent burns 257 +/- 73 microns. Inner nuclear layer defects were present only in lesions that clinically, during their acute stage, showed a white center or a white collar around the treated target. Fibrous subretinal and subpigment epithelial membranes extended from the burn centers for a distance of up to 900 microns and contained Müller cell processes as identified by immunostaining. These findings confirm the empirical rationale of current focal treatment, but also, because of the apparent risk of membrane formation, urge caution when treating close to the fovea.

Müller's cell involvement in proliferative diabetic retinopathy

To test whether the Müller's cell, and not the fibrous astrocyte alone, is an active glial element in proliferative diabetic retinopathy, we developed a method using enzyme histochemical analysis for carbonic anhydrase and immunolabelling for glial fibrillary acidic protein on plastic-embedded sections to detect Müller's cells in degenerated retinas. Four postmortem eyes with proliferative diabetic retinopathy were studied. Four features of Müller's cell behavior were observed: (1) Müller's cell nuclei migrated within the retina. (2) They were the principal glial cells in preretinal membranes. (3) Müller's cells formed horizontal bands, in the outer retina, that gave the appearance of subretinal membranes. (4) They formed intraretinal bridges between cystic spaces. In conclusion, the Müller's cell (or its progeny) plays an active role in proliferative diabetic retinopathy.

Microvascular changes in experimental branch retinal vein occlusion

Collateral vessel maturation and regional capillary nonperfusion were examined clinically and histopathologically up to 48 months after branch retinal vein occlusion (BVO) in a monkey model. Significant increases in endothelial density, but not pericyte density, were noted in both dilated and normal capillary caliber vessels in regions of collateral flow, independent of duration of BVO from 4 to 15 1/2 months. Patent capillaries in regions of hypoperfusion showed increased endothelial densities but decreased pericyte densities. Pericyte loss was independent of duration of BVO; however, endothelial density may normalize years after BVO in these vessels.

Recessive dystrophic epidermolysis bullosa

Recessive epidermolysis bullosa dystrophica (REBD), a bullous disorder of the skin and mucous membranes, is frequently associated with ocular complications. A 40-year-old woman presented with lid ulcerations, chronic conjunctivitis, diffuse subepithelial corneal scarring, corneal ulceration, and cataracts. Management with intensive lubricant therapy, soft-bandage contact lenses, and cataract extraction successfully restored her sight. Histologic examination via light and electron microscopy revealed blister formation and scarring beneath the epithelial basement membrane of both the skin and cornea, confirming the diagnosis of REBD. The ultrastructure of the skin and cornea and the ocular complications of the major forms of epidermolysis are described herein. To our knowledge, successful ocular management of a confirmed case of REBD with complete ocular histopathologic features has not been documented.

Fibronectin distribution in the rat eye. An immunohistochemical study

Previous studies of fibronectin (FN) distribution in eye tissue have relied on immunofluorescence (IF) techniques on frozen sections, and have not included the rat. Using rat eyes, a technique was developed for immunoperoxidase (IP) staining of formalin fixed paraffin embedded material, and the results were compared to those obtained by IF. IP was technically more difficult, and required pepsinization of tissue after formalin fixation to obtain consistent results. The optimum pepsin time varied for different structures in the eye. IP offers better tissue preservation and stain resolution. Results with IF were consistent with those observed with the newly applied IP. The distribution of FN in rat eyes was similar though not identical to that reported in other species. Prominent stain was observed in the conjunctiva, basement membrane of the corneal epithelium, corneal stroma, anterior aspect of Descemet's membrane, trabecular meshwork, perivascular stroma of the ciliary body, choroid and retinal blood vessels. Lens structures, vitreous, and internal limiting membrane of the retina were negative.

The anatomy and histology of the anophthalmic socket--is the myofibroblast present?

For some anophthalmic patients, the contracted socket is a severe problem that precludes the wearing of a prosthesis. A normal and cosmetically acceptable appearance is dependent on the ability of a socket to retain a prosthesis. The disfigurement and distress caused by the contracted socket and its inability to accommodate a prosthesis may have a profound detrimental effect on the patient's career, self-esteem, and psychosocial interactions. The tissue dynamics at work in the anophthalmic socket and in the contracting socket are not yet understood. There are many unanswered questions regarding the histology and anatomy of the normal, as well as the contracting, socket. The tissue responsible for clinical contraction has not been identified. This thesis, using the cynomolgus monkey socket as an experimental model, investigated healing in both the normal and contracting socket. Qualitative observations of the anatomy and histology of eight sockets were made. Two of the sockets were treated with Croton oil to induce contractions. Biopsy specimens from two human sockets, one contracted and the other merely volume deficient, were also examined. Histopathology of the normal and contracting sockets were compared. Myosin subfragment 1 staining of actin for electron microscopy and immunoperoxidase staining of actin for light microscopy were performed on selected specimens. The myofibroblast, probably a modified fibroblast, is known to be present in the early stages of open wound healing and in contracting scar tissue elsewhere in the body. The myofibroblast has been incriminated as an agent generating contractile force. Under the conditions of this experiment, cells with the characteristics of myofibroblasts were identified by both immunoperoxidase staining and electron microscopy. They were found in healing noncontracting and contracting sockets. Cytoplasmic actin was also distinguished in arterioles, venules, capillaries, myoepithelial cells, smooth muscle, and skeletal muscle.

HRP/trypsin technique for studies of the retinal vasculature

The HRP/trypsin technique is a new histologic method for the light microscopic study of the retinal blood vessels. A two-stage procedure, the first step results in a retinal whole amount preparation which permits visualization of the three-dimensional architecture of perfused vessels and their relationship within the retina. This allows analysis of gross vessel morphology and differentiation of deep and superficial vascular beds. The second step involves digesting the whole mount with trypsin and staining with hematoxylin. This permits detailed evaluation of the density of retinal capillary endothelial cells and pericytes, recognition of basement membrane ghosts, microaneurysms, and other intraretinal microvascular abnormalities, with intravascular horseradish peroxidase as a perfusion marker. This technique has been employed with success in studies of the retinal vasculature in both normal and RCS rat retinas, and in a monkey model of branch retinal vein occlusion.

Comparison of superoxide generation and luminol-dependent chemiluminescence with eosinophils and neutrophils from normal individuals

Although eosinophilia is found in many allergic and hypersensitivity diseases, the function of the eosinophil is not clearly established. To evaluate and characterize this function, anticoagulated blood from normal subjects was separated into purified populations of both eosinophils and neutrophils by a modified method for Percoll gradients. With this separation procedure, highly purified populations of eosinophils (95.0% +/- 2.1%) and neutrophils (97.2% +/- 0.4%) were obtained. Functional response of these two isolated granulocyte cell types was measured by luminol-dependent chemiluminescence (CL) and superoxide generation to opsonized zymosan and phorbol 12-myristate 13-acetate (PMA). Both the eosinophil and neutrophil peak CL response and superoxide generation to zymosan (1 mg), in the presence of autologous serum (10%), were identical. In contrast, when PMA (10(-4) to 10(0) micrograms/ml) was the stimulant, eosinophil CL was at least twofold greater than the neutrophil light emission (1,595,741 +/- 122,435 cpm/5 X 10(5) cells vs. 765,448 +/- 24,171 cpm/5 X 10(5) cells; n = 6). This same differential in responsiveness was seen in superoxide generation. Thus, under certain conditions the eosinophil's respiratory burst may be greater than that of the neutrophil, and this differential in metabolic activity may contribute directly to the eosinophil's inflammatory potential.

Subretinal new vessels after krypton laser photocoagulation

The eye of a patient with age-related macular degeneration was treated with krypton laser photocoagulation and later studied histopathologically. Five months after treatment the original membrane was completely obliterated, but a separate new membrane was found, which was fed by the retinal circulation and not by the choroid. The frequency of such recurrences is not known, but they may be related to krypton laser treatment.

Squamous cell carcinoma of the conjunctiva presenting with intraocular extension

A 73-year-old man, when first seen clinically, had extensive intraocular invasion from a limbal squamous cell carcinoma after only a six-week history of symptoms. This mode of initial presentation is rare for this tumor type.

Histopathology of focally photocoagulated preretinal new vessels

The histopathologic effects of focal xenon arc and argon laser photocoagulation on three patches of preretinal new vessels were studied in a patient with proliferative diabetic retinopathy. Both treatment modalities achieved total obliteration of the vessels. However, the adjacent retina and choroid were severely damaged, and preretinal membranes were seen over all three patches. Local tissue destruction is minimized when preretinal neovascularization is treated indirectly by scatter photocoagulation. Currently, scatter photocoagulation is our treatment of choice.

Actin filaments in contracting preretinal membranes

In 14 patients, preretinal membranes, causing retinal traction and severe visual impairment, were removed by vitrectomy and evaluated by light and electron microscopy using myosin subfragment-1 to stain actin filaments. Eight membranes were of vascular origin, six of nonvascular origin. All but one contained bundles of oriented actin filaments within a number of their nonvascular stroma cells, suggesting that the contractile protein action may have been involved in their clinically observed contraction.

Repair of the pigment epithelial barrier following photocoagulation

Mild argon laser burns produced in the retina of cynomolgus monkeys underwent differentiated retinal repair with frequent restoration of the pigment epithelial barrier. Permeability of the restored barrier was tested by two tracers injected intravenously--horseradish peroxidase followed by electron microscopic evaluation and fluorescein sodium followed by fluorescence microscopic examination of freeze-dried tissue. Tightness of the barrier was associated with regularly arranged pigment epithelial cells joined by zonulae occludentes. Leakage of the barrier was associated with discontinuities in the line of regularly proliferated pigment epithelial cells. At times, the tracers stained the pigment epithelial cells diffusely but they did not accumulate in the subretinal space. Variable changes in the choriocapillaris were noted. Mild photocoagulation may be effective in treating central serous choroidopathy in man when restoration of the pigment epithelial barrier is stimulated.

Posterior and anterior permeability defects? Morphologic observations on streptozotocin-treated rats

Structural abnormalities of the blood-ocular barrier were examined in streptozotocin (STZ)-treated hyperglycemic rats, after 9 days, 6 months, and 10 months' duration of "diabetes," and in normoglycemic control animals using the horseradish peroxidase tracer technique combined with light and electron microscopy. The most frequent abnormalities consisted of small areas of diffuse dense staining by the tracer of (1) the retinal pigment epithelium and (2) the nonpigmented ciliary epithelium. Pigment epithelium abnormalities occurred occasionally in both groups of animals with approximately equal frequency and extent. Ciliary body abnormalities occurred also in both groups, but were frequent; statistically, the probability of these changes was not significantly different between the two groups. At the ora serrata, tracer escape was present through the retinal pigment epithelium into subretinal space and retina. Retinal vascular leakage occurred rarely and may be related to tracer toxicity rather than hyperglycemia. Thus, using the HRP method, we cannot confirm the claim that sustained STZ-induced hyperglycemia causes breakdown of the blood-retinal barrier in the rat.

Actin filaments in diabetic fibrovascular preretinal membrane

A vitrectomy specimen from a diabetic patient was studied by light and electron microscopy using myosin subfragment 1 to decorate and identify actin filaments. The patient had proliferative diabetic retinopathy, a shrinking fibrovascular preretinal membrane associated with retraction of the thickened posterior hyaloid, and a localized traction retinal detachment. The fibrovascular tissue comprised normal mature collagen, few cells, and occasional blood vessels. The cells contained numerous thick bundles of the contractile protein, actin. We suggest that actin may have been involved in the contraction phenomena observed clinically and that membrane contraction might be blocked by pharmacologic treatment.

Actin filaments in retinal pericytes and endothelial cells

The contractile protein actin was identified within retinal capillary pericytes and endothelial cells. In capillary cross-sections, circumferential pericyte processes showed numerous parallel bundles of actin filaments forming a cap over the adjacent endothelial cells. The latter contained few actin filaments but a considerable number of intermediate filaments. Pericytes and endothelial cells communicated via gaps in the adluminal basal lamina. These special anatomic relationships are interpreted as evidence for a contractile role of retinal capillary pericytes and against a contractile role of retinal capillary endothelial cells

Endothelial fenestrae in proliferative diabetic retinopathy

The ultrastructure of old neovascular preretinal membranes was examined in both eyes of a patient with proliferative diabetic retinopathy treated in one eye with photocoagulation. Membranes in both eyes consisted of a matrix rich in mature collagen surrounding viable new vessels and "ghost vessels." Viable vessels of different calibers frequently showed endothelial fenestrae bridged by diaphragms. Occasionally tight junctions between endothelial cells appeared altered. Fenestrae and incompetent junctions may account for the characteristic "leakiness" of newly formed vessels.

Clinicopathologic correlation of xenon arc and argon laser photocoagulation. Procedure in human diabetic eyes

Xenon arc and argon laser lesions applied as scatter treatment to two diabetic patients were studied clinically and histopathologically. Seventy-one burns were grouped as very severe, severe, and moderately severe, according to pigmentation and diameter of the retinal scar. All lesions except half of the moderately severe ones showed full-thickness retinal involvement. In very severe xenon burns, whether xenon or argon, only proliferated retinal pigment epithelium provided a thin retinal scar, corresponding to an ophthalmoscopic appearance of "bare sclera". In the center of severe and moderately severe lesions, both glial cells and pigment epithelium bridged the retinal defect, forming a thick pigmented scar that contained pigment-laden macrophages. Rephotocoagulation over such thick scars may be less hazardous than is generally assumed. Nonvascular preretinal membranes were frequently present over very severe xenon lesions but rarely over very severe argon burns.

Septic choroiditis with serous detachment of the retina in dogs

The present study describes a model of multifocal septic choroiditis with serous retinal detachment after intracarotid injection of Staphylococcus aureus or Streptococcus faecalis. The fundus lesions occurred mainly in the tapetal area and, on ophthalmoscopic examination, were more extensive after S. aureus than after S. faecalis injection. On histopathologic examination there were microabscesses in the inner choroid and subretinal space, disrupting the outer retina but sparing the inner retina.

Experimental photocoagulation of the human retina. I. Correlation of physical, clinical, and pathologic data

Thirty-eight retinal burns were inflicted by a modified xenon-arc photocoagulator in the eyes of eight human volunteers. The ophthalmoscopic characteristics of these lesions were correlated with the degree of histopathologic damage. Definitive clinical criteria that helped to predict the severity of the retinal burns were established. The dose of radiant energy received was further correlated with the histopathologic changes in determining the threshold of safety standards of bright flashes of white light to the human eye. Lesions from patients with blue irises were produced by considerably higher dose rates than comparable lesions from patients with brown irises and the fovea was more susceptible to damage than the rest of the retina.

Experimental photocoagulation of the human retina. II. Electron microscopic study

Minimal retinal damage in xenon-arc photocoagulation lesions in man 14 hours to three days after exposure was confined to the retinal pigment epithelium (RPE) and consisted of accumulation of lysosome-related bodies in the cytoplasm. Slightly more intense damage consisted of dilation, vacuolization, and breakdown of the lamellae of the smooth-surfaced endoplasmic reticulum, preferentially around melanin-rich cell portions. Underneath more heavily vacuolated cells of the RPE, already in the periphery of ophthalmoscopically just-visible lesions, damage extended into the endothelial cells of the choriocapillaris and into the photoreceptor elements. Macrophages escaped from the choroidal circulation to appear on both sides of the Bruch membrane and within the subretinal space. More intense lesions showed features identical to those described in monkeys and are expected to show the same morphologic pattern of healing.

Permeability and patency of retinal blood vessels in experimental diabetes

Increased permeability of retinal blood vessels in human diabetic retinopathy is well known clinically. Its morphologic equivalent is unknown. In dogs with 5 years of poorly controlled alloxan diabetes and nonproliferative diabetic retinopathy comparable to that of man, permeability and patency of retinal blood vessels were tested with the protein tracer horseradish peroxidase and evaluated by electron microscopy. A breakdown of the blood-retinal barrier was found associated with extensive tracer leakage around retinal blood vessels. Tracer had seemingly permeated endothial junctions, and was not transported through the endothelial cytoplasm. Blood vessels which had lost their endothelial cells and were partially occluded by glial cells retained some patency to tracer. These findings suggest the following. (1) Endothelial tight junctions are not a static cell specialization but one that can open due to chronic metabolic or osmotic factors prevailing in diabetes. Opened tight junctions may account for plasma leakage seen clinically in human diabetic retinopathy. (2) In the absence of endothelial cells perfusion does not necessarily end abruptly. The tracer method and electron microscopy may show details of vascular obstruction that are not readily demonstrated clinically.