Vidinova C N, Vidinov K N
Department of Ophthalmology, Military Medical Academy, Sofia, Bulgaria.
Klin Monbl Augenheilkd. 2012 Dec;229(12):1204-8. doi: 10.1055/s-0032-1315307. Epub 2012 Sep 19.
Proliferative diabetic retinopathy (PDR) and age-related macular degeneration (AMD) are sight-threatening diseases with high social impact. The aim of our study is to compare the ultrastructure of PDR membranes and those in AMD with a special focus on the macrophages.
In our study 24 PDR patients and 11 AMD patients were enrolled. They all underwent complete ophthalmological examination including OCT. In all cases pars plana vitrectomy with excision of epiretinal or subretinal membranes was performed. Proliferations taken directly from the eye have been studied by transmission and scanning electron microscopy and with safranin O.
The fibrovascular proliferations in PDR consisted mostly of fibroblasts and occasional macrophages near the blood vessels. The prevailing type of blood vessels had one thin layer of endothelial cells, very thin basal membrane and no pericytes. Subretinal membranes in AMD patients consisted mainly of fibroblasts, isolated RPE cells and elements of the blood. Numerous macrophages and leukocytes in groups and clusters were found around the capillaries of subretinal blood vessels. The cells showed some peculiarities: diminished number of pseudopodia, altered shape. Groups of cytofilaments became visible in macrophages cell periphery. The number of proteoglycans in the matrix was increased.
Our results point out that macrophages play a key role in the formation of the fibrovascular proliferations in both PDR and AMD. Inflammation is assumed to act in the pathogenesis of both diseases. Probably the senescence of macrophages, which we found in our study, is responsible for their proangiogenic response and promotion of new vessel formation. It is reasonable to expect that anti-inflammatory therapy might be helpful in patients with AMD and PDR.
增殖性糖尿病视网膜病变（PDR）和年龄相关性黄斑变性（AMD）是具有高度社会影响的致盲性疾病。本研究旨在比较PDR膜与AMD膜的超微结构，特别关注巨噬细胞。
本研究纳入了24例PDR患者和11例AMD患者。他们均接受了包括光学相干断层扫描（OCT）在内的全面眼科检查。所有病例均行玻璃体切割术联合视网膜前或视网膜下膜切除术。直接取自眼部的增殖组织已通过透射电子显微镜、扫描电子显微镜和番红O染色进行研究。
PDR中的纤维血管增殖主要由成纤维细胞组成，血管附近偶尔可见巨噬细胞。主要类型的血管有一层薄的内皮细胞、非常薄的基底膜且无周细胞。AMD患者的视网膜下膜主要由成纤维细胞、孤立的视网膜色素上皮（RPE）细胞和血液成分组成。在视网膜下血管的毛细血管周围发现大量成簇的巨噬细胞和白细胞。这些细胞表现出一些特点：伪足数量减少、形状改变。巨噬细胞周边可见成组的细胞丝。基质中蛋白聚糖的数量增加。
我们的结果指出，巨噬细胞在PDR和AMD的纤维血管增殖形成中起关键作用。炎症被认为在这两种疾病的发病机制中起作用。我们在研究中发现的巨噬细胞衰老可能是其促血管生成反应和促进新血管形成的原因。可以合理预期抗炎治疗可能对AMD和PDR患者有益。
