Retinitis pigmentosa with segmental massive retinal gliosis. An immunohistochemical, biochemical, and ultrastructural study.

A morphologic, immunohistologic, and biochemical study was made on the eyes of a 79-year-old woman with clinically documented retinitis pigmentosa (RP). The methods included light and electron microscopy, immunohistologic staining, and biochemical analysis of interphotoreceptor retinoid-binding protein (IRBP) and cyclic nucleotides. Results from a histopathologic examination showed marked equatorial pigmentary retinal degeneration as well as peripheral chorioretinal atrophy corresponding to areas of paving stone chorioretinal changes. An unusual finding was a localized equatorial nodule in the right eye that stained with anti-glial fibrillary acidic protein (GFAP) antibodies, and showed lipid infiltrates in its margin and base. The equatorial retina showed marked gliosis of the outer layers. Photoreceptor cells were present only in the posterior retina, macula, and focally, in the far periphery. These areas corresponded to detectable IRBP assessed by immunohistochemical staining and biochemical analysis using the enzyme-linked immunosorbent assay (ELISA). Cyclic nucleotides were reduced in the peripheral retina, in areas of photoreceptor cell loss.