激光光凝后视网膜组织光镜观察和免疫组织化学研究

Histopathologic and Immunohistochemical Studies on Retina after Laser Photocoagulation

目的 观察人视网膜激光光凝后组织病理学和免疫组织化学的改变及其修复 ,为激光治疗眼底病提供理论基础。方法 7例因眼眶恶性肿瘤需作眶内容物剜出的视网膜基本正常的眼球 ,征得患者合作和签署同意书后 ,术前 1、3和 7d用 、 、 级光斑光凝视网膜 ,摘除眼球的视网膜用石蜡包埋、HE染色 ;再用 SP法 ,经抗体 S-1 0 0 ,GFAP、NSE和 NF免疫组织化学染色 ,光学显微镜观察。结果 组织病理学 :光凝后第 1 d, 级光斑见视网膜色素上皮细胞 (rpe)、感光细胞和外核层水肿破坏 ,细胞数减少 ; 级光斑示 rpe、感光细胞和外核层细胞大量溶解破坏 ; 级视网膜全层破坏严重。光凝后第 3d,视网膜水肿减轻 ,rpe细胞和胶质细胞开始增生。光凝后第 7d,rpe细胞和胶质细胞大量增生覆盖破坏区。免疫组织化学 :光凝后第 3d、7d见光斑区 S- 1 0 0和 GFAP染色 ,光凝后 1～7d光斑区 NSE和 NF未染色。结论 不同光斑的激光引起视网膜不同程度的破坏 ,破坏区由增生的 rpe和胶质细胞修复 。

Objective To observe the histopathologic and immunohistochemical changes and reparable process of retina after laser photocoagulation in order to provide a theoretical basis of laser treatment for fudus diseases. Methods Normal retina was photocoagulated using Ⅰ , Ⅱ , Ⅲ grade photic spot after the signing of informed consent of 7 patients who were suffering from orbital malignant tumors and in need of exenteration. The retinae from removed eyeballs were fixed with formalin, imbedded in paraffin and stained by H.E. The SP immunohistochemical method was adopted using antibodies of S 100, GFAP, NSE,and NF label. Results By histopathologyical examination, 1 day after photocoagulation with Ⅰ grade photic spot, the retinal pigment epithelium (RPE) cells, photoreceptors and cells in outer nuclear layer were edematous and necrotic, and decreased in number; with Ⅱ grade photic spot, many RPE cells, photoreceptors and cells in outer nuclear layer were lysed and destroyed; with Ⅲ grade photic spot, all layers of the retina were severely damaged. 3 days after photocoagulation, retinal edema was relieved. RPE and glial cells started proliferating. 7 days after photocoagulation, RPE and glial cells proliferated obviously to cover the destroyed areas. By immunohistochemistry, 3 7 days after photocoagulation, S 100 and GFAP were seen stained in the damage areas of photic spot. 1 7 days after photocoagulation, NSE and NF were found unstained in the photic spot. Conclusion The above data indicated that different laser photic spots resulted in various degrees of damage to the retina. The destroyed regions were repaired by proliferative RPE and glial cells. Immunohistochemistry confirmed that proliferative gial cells repaired damage retina, and neurons and nerve fibers could not regenerate, Laser could treat different retinal diseases.