Ebenezer G J, Daniel E
Department of Histopathology and Experiment Pathology, Schieffelin Leprosy Research and Training Center, Karigiri, Vellore District, Tamilnadu, India-632106.
Br J Ophthalmol. 2004 Feb;88(2):178-81. doi: 10.1136/bjo.2003.027276.
BACKGROUND/AIM: Peripheral nerve destruction is the hallmark of leprosy. Ocular complications form a substantial part of the clinical manifestations but histopathology of nerve destruction within ocular structures has not been shown satisfactorily. The role of protein gene product (PGP) 9.5 in identifying nerve destruction in the ciliary body and posterior ciliary nerves of lepromatous eyes is shown.
Serial sections from two lepromatous eyes and two non-lepromatous eyes were stained with PGP 9.5. Histopathological comparison was done on the expression of the PGP 9.5 stain in nerves within the ciliary body, posterior ciliary nerves adjacent to the optic nerve, and nerves tracking through the sclera.
In non-lepromatous eyes, PGP 9.5 was expressed in nerves within the ciliary body, the nerves within the sclera, and posterior ciliary nerves adjacent to the optic nerve. In lepromatous eyes no PGP 9.5 was expressed, signifying nerve destruction.
Nerve destruction in lepromatous eyes has been confirmed histopathologically by the absence of or patchy staining with PGP 9.5. Nerve destruction in the ciliary body can extend to the posterior ciliary nerves by an ascending axonopathy. This "dying back" phenomenon is akin to the "glove and stocking" anaesthesia found in lepromatous leprosy.
背景/目的：周围神经破坏是麻风病的标志。眼部并发症是临床表现的重要组成部分，但眼内结构神经破坏的组织病理学研究尚未令人满意地呈现。本文展示了蛋白基因产物（PGP）9.5在识别瘤型麻风病眼睫状体和睫状后神经神经破坏中的作用。
对两只瘤型麻风病眼和两只非瘤型麻风病眼的连续切片进行PGP 9.5染色。对睫状体内神经、视神经旁睫状后神经以及穿过巩膜的神经中PGP 9.5染色的表达情况进行组织病理学比较。
在非瘤型麻风病眼中，PGP 9.5在睫状体内神经、巩膜内神经以及视神经旁睫状后神经中表达。在瘤型麻风病眼中未检测到PGP 9.5表达，表明存在神经破坏。
通过PGP 9.5染色缺失或呈斑片状染色，从组织病理学上证实了瘤型麻风病眼存在神经破坏。睫状体内的神经破坏可通过轴索性逆行性病变扩展至睫状后神经。这种“逆向死亡”现象类似于瘤型麻风病中的“手套和袜套样”感觉缺失。
