Inomata H, Rao N A
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Ophthalmol. 2001 May;131(5):607-14. doi: 10.1016/s0002-9394(00)00851-5.
Although the depigmented, small, round to oval lesions seen in the sunset glow fundi of Vogt-Koyanagi-Harada disease are considered to represent Dalén-Fuchs nodules, there is no histopathologic evidence to support such a consideration. An attempt is made herein to clarify the nature of the atrophic lesions and distinguish them from Dalén-Fuchs nodules seen in eyes with Vogt-Koyanagi-Harada disease.
Eyes from five individuals with clinical diagnoses of Vogt-Koyanagi-Harada disease were subjected to histopathologic examination. The retinal pigment epithelial changes from early active to convalescent and late chronic recurrent stages were evaluated. Particular attention was paid to Dalén-Fuchs nodules, depigmented lesions in the sunset glow fundi, and hyperpigmentation of the chronic recurrent stage.
Eyes of two individuals, one in the active stage of Vogt-Koyanagi-Harada disease and the other in the convalescent stage, showed the presence of Dalén-Fuchs nodules. The depigmented small retinal pigment epithelial lesions were seen in two individuals, both of whom exhibited the sunset glow fundus of the convalescent stage. The retinal pigment epithelial lesions represented damage or disappearance of retinal pigment epithelial cells, and the sunset glow fundus appearance was from the loss of choroidal melanocytes. The heavy pigmentation seen in fundi with the chronic recurrent stage was the result of the proliferation of retinal pigment epithelial cells.
The Dalén-Fuchs nodule is a specific histologic change observed at the level of retinal pigment epithelium in patients with Vogt-Koyanagi-Harada disease. There is no histologic confirmation that the depigmented small atrophic lesions seen in the sunset glow fundi of Vogt-Koyanagi-Harada disease are Dalén-Fuchs nodules. The depigmented lesions represent localized damage or disappearance of retinal pigment epithelial cells.
尽管在Vogt-小柳-原田病晚霞样眼底中所见的色素脱失、小的圆形至椭圆形病变被认为代表了达伦-富克斯结节，但尚无组织病理学证据支持这一观点。本文旨在阐明萎缩性病变的性质，并将其与Vogt-小柳-原田病患者眼中所见的达伦-富克斯结节区分开来。
对5例临床诊断为Vogt-小柳-原田病的患者的眼睛进行组织病理学检查。评估了视网膜色素上皮从早期活动期到恢复期及晚期慢性复发期的变化。特别关注了达伦-富克斯结节、晚霞样眼底中的色素脱失病变以及慢性复发期的色素沉着。
两名患者的眼睛，其中一名处于Vogt-小柳-原田病的活动期，另一名处于恢复期，显示存在达伦-富克斯结节。两名患者均出现了色素脱失的小视网膜色素上皮病变，他们都表现出恢复期的晚霞样眼底。视网膜色素上皮病变表现为视网膜色素上皮细胞的损伤或消失，而晚霞样眼底外观是由于脉络膜黑素细胞的丧失。慢性复发期眼底所见的重度色素沉着是视网膜色素上皮细胞增殖的结果。
达伦-富克斯结节是Vogt-小柳-原田病患者视网膜色素上皮水平观察到的一种特定组织学变化。尚无组织学证实Vogt-小柳-原田病晚霞样眼底中所见的色素脱失小萎缩性病变是达伦-富克斯结节。色素脱失病变代表视网膜色素上皮细胞的局部损伤或消失。
