Coupland S E
Department of Cellular and Molecular Pathology, University of Liverpool, Royal Liverpool Hospital, Liverpool, UK.
Eye (Lond). 2008 Oct;22(10):1318-29. doi: 10.1038/eye.2008.31. Epub 2008 Mar 14.
Vitreous opacities are diverse in nature. Many underlying diseases are sight-threatening and several are also lethal. This review presents the pathologist's perspective of vitreous opacities, correlates laboratory findings with the underlying disease and recommends safe methods for handling specimens. An aetiological classification of vitreous opacities is also proposed.
A gentle fixative such as Cytolyt or HOPE-fixation is required, unless delivery of the vitreous biopsy specimen to the laboratory can be guaranteed within two hours. Cells and other material are precipitated onto slides or into cell blocks by centrifugation. Light microscopy with the May-Grunewald Giemsa stain is enhanced, as necessary, by the use of special stains, such as Congo red for amyloid, Perl's for iron, Periodic Acid-Schiff for microorganisms, and several others. Immunocytological methods enable cell typing, using labels such as CD3 for T-cells in reactive inflammation; CD20 for B-cells in retinal lymphoma; CD34 and myeloperoxidase for myeloid leukaemic cells. The polymerase chain reaction enhances the identification of organisms in endophthalmitis and of immunoglobulin rearrangements in lymphoma.
Acquired vitreous opacities can be classified according to their aetiology as: genetic; inflammatory non-infectious; inflammatory infectious; inflammatory iatrogenic; degenerative, traumatic; neoplastic and idiopathic. Non-diagnostic vitreous biopsies, unfortunately, still do occur with the main causes of failure including small sample size; sampling error; inadequate fixation; and leakage from container during transport.
Vitreous biopsy can profoundly influence the outcome in patients with vitreous opacities. Success depends on close collaboration between clinicians, pathologists and microbiologists. Vitreous samples require proper handling and expert application of a wide range of specialized techniques.
玻璃体混浊本质多样。许多潜在疾病会威胁视力，有些还会致命。本综述从病理学家的角度阐述玻璃体混浊，将实验室检查结果与潜在疾病相关联，并推荐安全的标本处理方法。还提出了玻璃体混浊的病因分类。
除非能保证在两小时内将玻璃体活检标本送达实验室，否则需要使用如Cytolyt或HOPE固定液等温和的固定剂。通过离心将细胞和其他物质沉淀到载玻片上或制成细胞块。必要时，使用特殊染色（如刚果红染淀粉样蛋白、Perl氏法染铁、过碘酸希夫氏法染微生物等）增强苏木精-伊红染色的光学显微镜检查效果。免疫细胞学法可进行细胞分型，如在反应性炎症中用CD3标记T细胞；在视网膜淋巴瘤中用CD20标记B细胞；用CD34和髓过氧化物酶标记髓系白血病细胞。聚合酶链反应可增强眼内炎中病原体的鉴定以及淋巴瘤中免疫球蛋白重排的鉴定。
后天性玻璃体混浊可根据病因分为：遗传性；非感染性炎症性；感染性炎症性；医源性炎症性；退行性、外伤性；肿瘤性和特发性。不幸的是，仍会出现无法诊断的玻璃体活检情况，主要失败原因包括样本量小；采样误差；固定不充分；以及运输过程中容器泄漏。
玻璃体活检可对玻璃体混浊患者的治疗结果产生深远影响。成功取决于临床医生、病理学家和微生物学家之间的密切合作。玻璃体样本需要妥善处理，并由专家应用多种专门技术。
