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Sachdeva MM, Jakobiec FA, Stagner AM, et al.



硅油 超微 网膜


目的:视网膜切除术越来越多地用于增生性玻璃体视网膜病变(PVR)相关的视网膜脱离修复。视网膜切除术将视网膜色素上皮(RPE)暴露于玻璃体腔;硅油对RPE的直接影响才开始被理解。设计:各种病例系列。研究对象:使用硅油填充物和视网膜切除术修复复杂的视网膜脱离后定期进行随访时,12名患者注意到出现视网膜上皮色素沉积。方法:通过广角彩色摄影,眼底自体荧光成像和光谱域光学相干断层扫描(SD OCT)描述视网膜色素沉积的临床特征。除去硅油时,将着色的膜保留在固定剂中,并通过光学显微镜/免疫染色或电子显微镜描述组织学特征。主要预后指标:无适用指标。结果:我们描述了硅油视网膜切除手术治疗复杂PVR脱离后12只发生弥漫性视网膜前色素沉积的眼,术后平均3.2个月发病。这些色素团在眼底自体荧光成像上产生了醒目的豹斑图样。硅油清除时剥离的黄斑部视网膜前膜组织病理学和超微结构分析显示细胞内具有硅油滴的RPE细胞,细胞内分散着膜结合黑色素颗粒,胶质组织(1例)和纤维性基质。结论:虽然体内研究已经表明RPE细胞可以吞噬乳化油滴,但本报告通过电子显微镜首次公布了患者的体内特征。这些研究结果强调了直接接触硅油可能会影响RPE的行为,这可能与已经进行硅油填塞视网膜切除术治疗视网膜脱离的患者存在临床相关。

PURPOSE:Large relaxing retinectomies have become increasingly used in the repair of retinal detachment related to proliferative vitreoretinopathy (PVR). Retinectomies expose the retinal pigment epithelium (RPE) to the vitreous cavity; the direct effects of silicone oil on the RPE are only beginning to be understood.DESIGN:Retrospective case series.PARTICIPANTS:Twelve patients noted to develop pigmented epiretinal deposits at regularly scheduled follow-up visits after repair of complex retinal detachments using silicone oil tamponade and retinectomy.METHODS:Epiretinal pigment deposits were characterized clinically by wide-field color photography, fundus autofluorescence imaging, and spectral-domain optical coherence tomography (SD OCT). At the time of silicone oil removal, the pigmented membranes were preserved in fixative and analyzed by light microscopy/immunostaining or electron microscopy for histologic characterization.MAIN OUTCOME MEASURES:Not applicable.RESULTS:We describe the development of diffuse preretinal pigmentary deposits in 12 eyes after surgery for complicated PVR detachments using retinectomies with oil, with an average onset of 3.2 months postoperatively. These pigment clumps produced a striking leopard-spot pattern on fundus autofluorescence imaging. Histopathologic and ultrastructural analysis of these epiretinal proliferations peeled at the time of silicone oil removal revealed RPE cells with intracellular silicone oil droplets, singly dispersed membrane-bound melanin granules, glial tissue (1 case), and a fibrous stroma.CONCLUSIONS:Although invitro studies have suggested that RPE cells can phagocytose emulsified oil droplets, this report represents the first invivo documentation by electron microscopy of this phenomenon in patients. These findings underscore that direct contact with silicone oil may affect the behavior of the RPE, which may be clinically relevant in patients who have undergone large relaxing retinectomies with silicone oil tamponade for PVR-related retinal detachments.


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