血液不同成分对眼后节穿孔伤眼内细胞增生的影响

将自体血液的不同成分,即血红蛋白、白细胞和血清分离后分别注入兔眼穿孔伤模型的玻璃体内,结果表明血红蛋白和白细胞都使90%以上的眼出现玻璃体内纤维血管增生。增生的细胞主要来源于巩膜伤口,一些来源于无色素睫状上皮和视盘表面。白细胞注入组眼内增生较明显。血红蛋白注入后出现以巨噬细胞为主的炎症反应。血清对眼内增生的影响不显著。提示炎细胞在外伤性眼内细胞增生中起重要作用。     

严重PDR玻璃体切割术后雷珠单抗注射的效果观察

目的：对严重增殖性糖尿病视网膜病变的患者行玻璃体切割术后行雷珠单抗注射的效果观察。方法：回归性分析。12例严重增殖性糖尿病视网膜病变患者(12眼)接受睫状体平坦部玻璃体切割术,同时给予硅油、惰性气体或者平衡液的玻璃体腔填充。在手术结束的同时给予雷珠单抗的玻璃体腔注射。结果：随访时间平均为2.75 mo。这12眼中分别包括玻璃体积血(1眼);玻璃体积血伴纤维血管化增生(1眼);玻璃体积血伴牵拉性视网膜脱离(3眼);纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴纤维血管化增生伴牵拉性视网膜脱离(2眼);玻璃体积血伴纤维血管化增生伴新生血管性青光眼伴牵拉性视网膜脱离(1眼);玻璃体积血伴牵拉性孔源性视网膜脱离(1眼)。12眼中,8眼行玻璃体腔硅油填充,2眼行惰性气体填充,2眼行平衡液填充。所有的患者之前均未接受任何治疗。视网膜脱离复位率为10/10(100%)。1眼术后出现前房积血。9眼术后最佳矫正视力较术前提高,2眼无明显变化,1眼较术前下降。 OCT检查显示8眼术后未见黄斑水肿。结论：玻璃体切割术后雷珠单抗注射对严重增殖性糖尿病视网膜病变患者有明显的治疗效果：手术成功率明显提高;患者视力显著提高;糖尿病黄斑水肿的发生概率减少;术中及术后并发症的发生率降低。     

Histology of wound, vitreous, and retina in experimental posterior penetrating eye injury in the rhesus monkey.

We performed a histologic study to support our clinical observations on the mechanisms responsible for traction retinal detachment after a penetrating injury in the rhesus monkey eye. The monkey eyes (40 eyes; 40 monkeys) were characterized by intraocular fibrosis with the formation of a cyclitic membrane and epiretinal and subretinal membranes. The progression to a fibrous ingrowth from the wound occurred only in eyes with blood in the vitreous. The intravitreal fibroblastic proliferation had its origin mainly from the stroma of the ciliary body and choroid at the wound but probably also from the nonpigmented ciliary epithelium. A fibroblastic response was present within the vitreous as early as four days after injury, and had progressed to form a cyclitic membrane by six weeks. Epiretinal membranes were identified as early as four weeks after injury. They were most prominent over the peripheral retina anterior to the equator. It is likely that they are derived from multiple cellular sources including the fibrous ingrowth from the wound but they were also connected to the surface of the retina by bridges of tissue indicating a glial origin. The subretinal membranes appeared to be derived from both retinal pigment epithelium cells and glial cells.     

Experimental intravitreal proliferation and neovascularization in the cynomolgus monkey

An experimental model for intravitreal cellular proliferation was produced by injection of carbon micro- particles into the vitreous of nine cynomolgus monkeys. Eighteen eyes were studied following enucleations 10 weeks after the injections. Histological examinations showed retinal folds or detachments in 16 eyes, while 6 of those had total detachments. Eight eyes contained transvitreal fibro- vascular strands, passing from the optic disk to a cyclitic retrolental membrane. The strands and membranes were composed mainly of infiltrates of macrophages, inflammatory cells, fibroblasts, newly formed vessels and van Gieson- staining collagen. Epiretinal proliferation of glial cells also occurred. These experiments indicate that a primarily phagocytic cellular invasion into the vitreous is capable of stimulating further cellular migration and growth and for inducing fibrovascular proliferations.Presented at the 1984 meeting of the Club Jules Gonin in Lausanne, Switzerland     

Results of vitrectomy for proliferative diabetic retinopathy

The authors treated 1007 eyes with vitrectomy for complications of proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 353 eyes (35%); traction retinal detachment, 360 eyes (36%); combined traction-rhegmatogenous retinal detachment, 172 eyes (17%); and other progressive fibrovascular proliferation 122 eyes (12%). During the study period, the frequency of vitreous hemorrhage as an indication for surgery decreased from 42 to 25%, and other progressive fibrovascular proliferation increased from 5 to 22%. The frequency of traction and traction/rhegmatogenous retinal detachments did not change. The results of surgery varied according to the indication. Seventy-nine percent of eyes with vitreous hemorrhage obtained final vision of 5/200 or better. Similar results were obtained in 64% of eyes with traction detachment, 56% of eyes with rhegmatogenous detachment, and 81% of eyes with progressive fibrovascular proliferation. The percentage of eyes achieving final vision of 20/100 or better are as follows: vitreous hemorrhage, 48%; traction detachment, 27%; rhegmatogenous detachment, 24%; and progressive fibrovascular proliferation, 46%. The success rate improved in each anatomic category during the last 3 years of the study.     

Anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy

Vitrectomy was performed to treat 74 consecutive eyes for complications of diabetic retinopathy. Eight (13%) of 61 eyes followed up for an average of 12 months developed anterior hyaloidal fibrovascular proliferation. This was the most common postoperative complication, whose features included recurrent hemorrhages into the vitreous cavity or anterior vitreous, or both; vessels or fibrovascular tissue on the posterior lens capsule; anterior extraretinal vascularization extending toward the lens on the anterior hyaloid; traction detachment of the peripheral retina or ciliary body; and hypotony. Patients who developed this complication tended to be young males with severe retinal neovascularization and extensive retinal ischemia; traction retinal detachment as an indication for surgery; placement of a scleral buckle; postoperative rubeosis iridis, recurrent vitreous hemorrhages, and retinal detachment; and multiple surgeries. Four eyes progressed to atrophia bulbi. Early recognition followed by additional surgery in two patients and extensive additional photocoagulation in two other patients was successful in preserving good visual function.     

Penetrating eye injuries: a histopathological review.

This study reports the histological findings in human eyes after severe penetrating trauma. The findings confirm the high incidence of retinal detachment in eyes with severe penetrating injuries. The retina was detached in 32 out of the 34 eyes examined, with 27 having evidence of traction on the retina. These eyes were characterized histologically by intraocular cellular proliferation producing cyclitic, epiretinal, and retroretinal membranes. Intraocular cellular proliferation was discernible or established within 1 week of injury and typically resulted in a cyclitic membrane at about 6 weeks. Epiretinal and retroretinal membranes were found between 1 and 2 weeks after injury in eyes with a detached retina. The results indicate that a damaged lens, the admixture of lens material and vitreous, and the presence of vitreous haemorrhage were all factors promoting intravitreal fibroblastic proliferation. Vitreous surgery may be a rational method of treatment for these severely injured eyes by removing the stimulus and vitreous scaffold for intravitreal fibroblastic proliferation. From this series it would appear that vitrectomy should not be delayed beyond the second week of injury, by which time massive cellular ingrowth may already be under way.     

Fibrovascular proliferation and retinal detachment after intravitreal injection of activated macrophages in the rabbit eye

Injection of activated macrophages into the posterior vitreous of the rabbit induced vigorous fibrovascular proliferation over the optic disk and medullary rays, as demonstrated by 3H-thymidine autoradiography. One week after injection, endothelial cells and pericytes of the capillaries near the inner surface of the optic disk and rays were labeled; fibroblast-like cells, which were also labeled, migrated and formed vitreous strands. By the second week after injection, the fibrovascular tissue proliferated most actively, and traction medullary ray detachment and peripapillary retinal fold formation were observed. The cellular proliferation was accompanied by inflammatory cell infiltration. Glial cells within the optic disk, as well as retinal pigment epithelial cells beneath the detached retina, were labeled by 3H-thymidine. These results demonstrate that the fibrovascular proliferation originates from the vessel complex of the optic disk and medullary rays in this experimental model of retinal detachment.     

Pathogenetic mechanisms in anterior proliferative vitreoretinopathy.

A clinicopathologic study of ten consecutive patients (ten eyes) undergoing surgery for rhegmatogenous retinal detachment with anterior proliferative vitreoretinopathy and a subsequent histopathologic, immunohistochemical, and ultrastructural study of ten enucleated eyes with anterior proliferative vitreoretinopathy were performed in order to elucidate relevant pathogenetic mechanisms. Our findings suggest that the pathogenetic evolution of anterior proliferative vitreoretinopathy occurs in three consecutive stages: (1) traction on the ciliary body and peripheral retina induced by fibrocellular contraction of the vitreous base; (2) incorporation of tractionally denuded components of the ciliary body and peripheral retina into the fibrocellular membranes overlying the vitreous base; and (3) proliferation of the incorporated components and fibrovascular ingrowth from the uvea, the retina, or both, into the fibrocellular membranes. Tractional disruption of the epithelium of the ciliary body pars plicata and breakdown of the ciliary blood-aqueous barrier are the principal pathogenetic mechanisms of chronic intractable hypotony and the post-vitrectomy fibrin syndrome in anterior proliferative vitreoretinopathy.     

Comparative studies in chronic ocular chalcosis

Seven eyes containing a copper foreign body for a period from 8 months to 2.5 years were studied histopathologically. Foreign bodies, containing 99% copper, were in all eyes, encapsulated and located in the anterior vitreous. Characteristic features were: formation of foreign body granuloma, especially in later stages, marked fibroblastic proliferation in the vitreous with traction retinal detachment, choroidal effusion with fibrosis and foci of chronic nongranulomatous inflammation in cyclitic membranes, iris, ciliary body and sclera. Copper could be identified by rubeanic acid and rhodanine stainings in the fibrous capsule around foreign body in all eyes, in the lens capsule in one eye and in macrophages in the vitreous and retina in 2 eyes. In eyes with intravitreal haemorrhage macrophages contained also haemosiderin.     

Vitreoschisis in Eales' disease: pathogenic role and significance in surgery

PURPOSE: To report the surgical anatomy of vitreoretinal adhesions as observed intraoperatively in patients undergoing vitreous surgery for complications of Eales' disease. METHODS: Eighteen consecutive male patients (18 eyes) undergoing vitrectomy for Eales' disease were studied prospectively. Intraoperative diagnosis was vitreous hemorrhage (VH) in nine cases, traction retinal detachment (TRD) in four, VH and TRD in three, and combined traction-rhegmatogenous retinal detachment in two. Epiretinal membranes (ERMs) obtained during surgery were studied using light microscopy and immunohistochemistry. RESULTS: An incomplete posterior vitreous detachment was observed in all eyes. Multifocal vitreoretinal adhesions were evident in 83.3% of eyes. The proliferation was fibrovascular in 10 eyes and fibrous in eight. A radial traction fold extending from optic disk to periphery was observed in three eyes. A double-layered membrane, probably the result of vitreoschisis, caused tangential traction. ERMs consisted principally of type II collagen and the cellular element was predominantly composed of lymphocytes, glial cells, and macrophage-like cells (probably hyalocytes). CONCLUSIONS: Fibrous and fibrovascular proliferations have multiple areas of adhesions to the posterior vitreous cortex. The presence of type II collagen in the ERM indicates a possible vitreous collagen component to the double-layered membranes (vitreoschisis). Recognition of the double-layered membranes aids in relief of traction during surgery by delamination.     

Anterior proliferative vitreoretinopathy. Clinicopathologic, light microscopic, and ultrastructural findings

Proliferative vitreoretinopathy (PVR) involving the posterior and equatorial retina is an established clinicopathologic entity. Clinically, a similar process, anterior PVR (APVR), results in anterior dragging of the peripheral retina by membranes which connect to the ciliary body or iris and cause circumferentially and radially fixed retinal folds. The pathology of APVR, however, has not been reported. The authors describe pathologic findings in 28 cases of APVR and ultrastructural pathologic findings in 6 surgical APVR specimens. Anterior PVR was frequently associated with retinal detachment (RD) repair (96%) and trauma (38%). Residual vitreous at the vitreous base virtually always provided a scaffold for membranes containing proliferating cells and deposited extracellular matrix. Major components of APVR membranes were fibrovascular tissue (71%), pigment epithelial cells (43%), fibrous and corneal stromal ingrowth (32%), and glial proliferation (18%). Because of its anterior location, APVR membranes also incorporated ciliary epithelium and corneal endothelium. Contraction of APVR membranes caused anterior retinal displacement and detachment in anatomic configurations corresponding to narrow and wide peripheral troughs. The authors' findings indicate that APVR is a distinctive clinicopathologic entity which may complicate rhegmatogenous RD and its repair.     

Clinicopathologic findings in anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy

Two young patients (27 and 30 years old, respectively) with long-standing diabetes mellitus underwent vitreoretinal surgery for traction retinal detachment and vitreous hemorrhage. The postoperative course in each was characterized by early recurrence of the hemorrhage into the vitreous cavity, hypotony, and severe visual loss. Histopathologic examination of both operated on eyes showed anterior extraretinal fibrovascular proliferation extending along the anterior hyaloid to the posterior lens surface, causing traction detachments of the peripheral retina and ciliary body. The vessels originated from the anterior retina. There was no evidence of excess fibrous tissue at the well-healed sclerotomy wounds.     

Experimental posterior penetrating eye injury in the rabbit. II. Histology of wound, vitreous, and retina.

The histological findings of the wound, the vitreous, and the retina in the rabbit eye with experimental posterior penetrating injury are described. Wound healing had just begun at 3 days after injury and was well established by 9 to 12 days. It involved proliferation of cells from the episclera and from the choroid. The progression to a fibrous ingrowth from the wound occurred only in eyes with blood in the vitreous. The intravitreal fibroblastic proliferation had begen at 6 days after injury and seemed to be derived from the choroid, the nonpigmented ciliary epithelium and, posteriorly, from the optic nervehead. During the development of retinal detachment the configuration of the peripheral and posterior retina, together with the orientation of vitreous strands, suggested the presence of vitreous traction. We postulate that the presence of contractile fibroblasts (myofibroblasts) in the vitreous may provide the mechanism for vitreous traction. The retinal detachments were also characterised by epiretinal and subretinal membranes, but these were not prominent. The end-stage appearance of a soft, shrunken eye with cyclitic membrane formation and retinal detachment resembles the outcome in many human eyes after severe penetrating injuries.     

环孢素A缓释系统眼内植入治疗葡萄膜炎的实验研究

目的探讨环孢素A缓释系统(CsA DDS)玻璃体腔植入治疗实验性葡萄膜炎的有效性和安全性。方法43只新西兰白兔中,其中30只建立葡萄膜炎动物模型,按照随机数字表法分为4组,即空白对照组(A)6只、空白DDS植入组(B)6只、CsA口服治疗组(C)6只及CsA DDS植入组(D)12只,于术后不同时间点观察各组兔眼前房闪辉、房水细胞、前房渗出、玻璃体细胞以及玻璃体混浊度并进行分级,并进行视网膜电图(ERG)、眼和肝、肾组织病理学检查;余13只新西兰兔右眼植入CsA DDS,检测玻璃体腔CsA药物浓度。结果(1)30只实验兔均成功诱发葡萄膜炎模型。各时间点A、B、C组各项炎性指标分级均高于D组,A、B组间及C、D组间差异无统计学意义(P>0.05),D组与A、B组间差异有统计学意义(P<0.05);ERG检查显示A、B两组b波波幅降低幅度均较D组明显,差异有统计学意义(P<0.05);A、B组睫状体和视网膜有大量炎性细胞浸润,组织明显破坏,而C、D组则未见炎性细胞浸润,组织结构基本完整。(2)CsA DDS植入术后玻璃体腔药物浓度在1个月时达到(491.0±481.6)ng/ml,2个月时为(575.2±373.2)ng/ml,3个月时缓慢下降至(301.5±128.5)ng/ml。光镜检查未见眼内毒性反应。结论CsA DDS玻璃体腔植入能够在眼内维持安全有效的药物浓度,明显减轻兔眼葡萄膜炎性反应,为葡萄膜炎的治疗提供了一种新的用药途径。     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

糖尿病视网膜病变玻璃体切除术后玻璃体出血的临床分析

目的 探讨糖尿病视网膜病变(DR)玻璃体切割手术后玻璃体积血的原因，处理措施以及对预后的影响。 方法 回顾性分析98例DRⅣ期患者122只眼行玻璃体手术治疗后发生玻璃体积血25只眼的临床资料。 结果 玻璃体切割手术后发生玻璃体积血占本组玻璃体切割手术患者的20.5%。积血发生在手术后1周内者8只眼，1周至1个月者6只眼，1个月以上者11只眼。25只眼中C₃ F₈填充眼占31.1%,硅油填充眼占6.1%；空气填充眼占33.3%；灌注液填充眼占26.3%。视网膜周边部新生血管增生9只眼。3只硅油填充眼中2只眼积血自行吸收，1只眼局部形成视网膜前膜，在硅油取出同时行前膜剥除；22只非硅油填充眼中6只眼积血自行吸收；2只眼积血加重，但未及时处理，1只眼发生新生血管性青光眼，1只眼广泛玻璃体视网膜增生脱离，视力无光感；14只眼观察2周积血无吸收后进行了再次手术治疗，12只眼1次手术处理后未再积血。随访结束时，视力无光感者3只眼，手动者2只眼，数指～0.1者10只眼，0.3及以下者4只眼，0.3以上者6只眼。 结论 DR玻璃体切割手术后发生玻璃体积血的患者多数有周边部新生血管增生，经过及时手术治疗，预后较好。 (中华眼底病杂志,2007,23:241-243)     

Characteristics and outcomes of anterior hyaloidal fibrovascular proliferation in lasered retinopathy of prematurity. The Indian Twin Cities Retinopathy of Prematurity Study (ITCROPS) report number 4

To describe the characteristics and treatment outcomes of an unreported, late vitreous hemorrhage due to anterior hyaloidal fibrovascular proliferation in laser-regressed retinopathy of prematurity (ROP). Interventional case series. In the ongoing Indian Twin Cities ROP study database, consecutive cases with isolated late vitreous hemorrhage at least one year after laser-regressed disease were analyzed retrospectively. Anterior hyaloidal fibrovascular proliferation was diagnosed primarily using scleral depression. Anterior retinal cryopexy with adjunctive treatments was performed. The main outcome measure was clinical resolution of new vessels with no recurrent hemorrhage over a 1-year period. Vitreous hemorrhage, at two to eight years of age, developed in three eyes of three children out of 1,168 ROP lasered eyes. All had received laser for zone I disease as neonates, with no subsequent sequelae. Evaluation revealed filiform new vessels at the posterior vitreous base involving inferior 180° with absence of any other source of hemorrhage. All underwent anterior retinal cryopexy to the affected area. Simultaneous additional treatment, based on intraoperative findings, included one case each of peripheral laser photocoagulation, lens-sparing vitrectomy and intravitreal bevacizumab. All three showed successful regression and non-recurrence of vitreous hemorrhage with improvement of vision >20/40 at an intermediate follow-up of two years. Anterior hyaloidal fibrovascular proliferation is an unreported and rare cause of vitreous hemorrhage, appearing years after laser-regressed ROP. It has a good response to interventional treatment. Meticulous scleral depression of the vitreous base under anesthesia is useful to detect this rare source of vitreous hemorrhage.     

Vitrectomy in the management of diabetic eye disease.

Vitrectomy techniques including endolaser photocoagulation allow visual rehabilitation in many eyes that are otherwise untreatable. Discerning the indications and timing for diabetic vitrectomy is increasingly important as the treatment of complications of diabetic retinopathy continues to undergo modification and redefinition. The most common indications for diabetic vitrectomy include: 1) severe nonclearing vitreous hemorrhage; 2) traction retinal detachment recently involving the macula; 3) combined traction and rhegmatogenous detachment; 4) progressive fibrovascular proliferation; and 5) rubeosis iridis and vitreous hemorrhage for eyes in which the media opacity has prevented adequate laser photocoagulation. Other less common indications in selected cases include dense premacular hemorrhage, ghost cell glaucoma, macular edema with premacular traction, cataract preventing treatment of severe, proliferative diabetic retinopathy, anterior hyaloidal fibrovascular proliferation, and fibrinoid syndrome with retinal detachment. The rationale and surgical objectives are discussed and results are summarized.     

Intravitreal injection of bevacizumab and gas for diabetic premacular hemorrhage with active fibrovascular proliferation

Background  To report the effect of intravitreal injection of bevacizumab and gas for the treatment of diabetic premacular hemorrhage with active fibrovascular proliferation. Methods  Six eyes of six consecutive patients with acute diabetic premacular hemorrhage and active fibrovascular proliferation received intravitreal injection of bevacizumab (1.25 mg in 0.05 mL) and C3F8 (0.2–0.3 mL) during the same setting. All six cases had panretinal photocoagulation prior to the procedure. After treatment, patients maintained a prone position for 3 days and were followed for an average of 8 months (range, 4–13 months). Results  All six eyes had complete reabsorption of the hemorrhage and reduction of fibrovascular proliferation. Transient vitreous opacification from breakthrough of the blood were observed in all eyes. An average of 3.8 weeks (range, 1–6 weeks) was required for the clearing of preretinal hemorrhage. Visual acuity improved in all six eyes. No recurrent bleeding or other adverse events were encountered in all cases. Conclusions  Intravitreal injection of bevacizumab and gas may be an effective method for treating acute diabetic premacular hemorrhage with active fibrovascular proliferation. The authors do not have any proprietary interests in the material used in this study. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data upon request. ClinicalTrials.gov ID: NCT00673296. The study was approved by the institutional research board of National Taiwan University Hospital (NTUH-REC No. 200711050R).