眼内硅油填充术后硅油相关并发症的组织病理及超微结构观察

Histopathological and ultrastructural characteristics of oil-associated complications in silicone oil-filled human eyes

目的观察眼内硅油填充术后硅油相关并发症的组织病理及超微结构改变,并探讨其发生机制。方法收集中山大学中山眼科中心病理室有眼内硅油填充术史的25例病理标本,其中包括眼球8例,眼内容物1例,视网膜前膜4例,角膜4例及晶状体8例,对其进行组织病理学观察及免疫组化分析,对其中获得的2例新鲜前膜组织行电镜下观察。结果眼内硅油填充术后硅油相关角膜病变以内皮细胞消失(90%)、带状角膜变性(83%)为主;而硅油相关白内障则以上皮细胞纤维化生为主。8例眼球及1例眼内容物组织见到典型硅油相关视网膜病变,即视网膜结构紊乱,增殖膜形成,其内较多大小不一的圆形硅油泡,神经元细胞数量减少。3例硅油存留时间>60个月的眼球,视网膜组织已完全被增殖膜替代,且硅油广泛浸润至角巩缘陈旧创口、小梁、虹膜睫状体、脉络膜、视神经及其鞘膜组织内,提示随着硅油在眼内存留时间的延长,硅油并发症更广泛、严重。2例视网膜前膜光镜下仅见少量硅油,但电镜下可见典型硅油浸润。免疫组化检查结果在硅油浸润部位,可见散在或灶性CD68阳性巨噬细胞;油泡周围的包裹膜部分胶质纤维酸性蛋白阳性、部分波形蛋白阳性,提示硅油可通过巨噬细胞向邻近组织浸润。结论眼内硅油填充术后硅油长期眼内存留可导致眼组织结构和(或)功能异常,应在视网?

Objective To observe morphological changes of oil-associated complications in silicone oil-filled human eyes, and to further explore their pathogenesis. Methods The morphology analysis and immunohistochemistrical study were performed in 25 specimens including 8 eyeballs, 1 ocular content, 4 preretinal membranes, 4 corneal buttons and 8 lens from human eyes with silicone oil tamponade. Two of preretinal membranes acquired freshly were also evaluated by transmission electron microscopy(TEM). Results Endothelium cell loss (90%) and band keratopathy(83%) were the most typical changes in silicone oil-associated keratopathy;while epithelial cell fibrosis was the most frequent histopathological features in silicone oil-associated cataract. In 8 eyeballs and 1 ocular content, it was found that damages to normal retinal layers and formation of preretinal or subretinal membrane with extensive silicone bubbles were obvious in the cases of silicone oil-associated retinopathy, which included loss and degeneration of neuron cells. Moreover, in 3 eyeballs with silicone oil for more than 60 months,retinas were completely replaced by fibril membranes,and the oil vacuoles were also found in sclerocorneal scar, trabecula, iris, ciliary body, choroid, optic nerve and its tunica vaginalis. These finding demonstrated that the longer the silicone oil was retained in eyeballs, the more severe its complications were. Different sizes of silicone bubbles in 2 preretinal membranes were noted easier by TEM than light microscopy. There were some macrophages marker (CD68)positive staining cells in the tissues filled with silicone bubbles, such as preretinal or subretinal membrane and optic nerve. Partial of the membranes surrounding the oil bubbles was positive for GFAP staining, and other part was positive stained for Vimentin. Conclusions Intraocular silicone oil can damage the normal tissue structures and function if it is retained in eyeballs too long. This results suggest that silicone oil should be removed timely after the retinal reattachment stabilized and can not be used as a kind of long term intraocular tamponade.