Jonas Jost B, Ohno-Matsui Kyoko, Holbach Leonard, Panda-Jonas Songhomitra
Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
Acta Ophthalmol. 2020 Nov;98(7):e856-e863. doi: 10.1111/aos.14405. Epub 2020 Mar 19.
Since histomorphometric descriptions of posterior scleral staphylomas, although forming a major part of myopic maculopathy, have been scarce so far, we histomorphometrically examined scleral staphylomas in enucleated human eyes.
Using light microscopy, we histomorphometrically examined sagittal histological sections of human globes enucleated due to malignant choroidal melanomas or secondary angle-closure glaucoma.
Out of 246 globes included into the study, posterior scleral staphylomas were detected in 10 eyes (mean length: 31.4 ± 3.0 mm; range: 28.0-37.0 mm). In the staphylomatous region in the study group as compared with the corresponding region of a control group adjusted for age and axial length, scleral thickness was significantly lower (109 ± 25 µm versus 319 ± 161 µm; p = 0.001). The study group in the staphylomatous region as compared to the highly myopic control group in the corresponding region did not differ significantly in retinal pigment epithelium (RPE) cell density (19.6 ± 4.9 cells/300 µm versus 21.1 ± 5.7 cells/300 µm; p = 0.84) and RPE height (8.2 ± 2.8 µm versus 6.1 ± 2.5 µm; p = 0.13), Bruch's membrane (BM) thickness (3.5 ± 1.3 µm versus 4.2 ± 2.3 µm; p = 0.40) and choriocapillaris thickness (5.3 ± 2.8 µm versus 4.4 ± 2.8 µm; p = 0.49) and density (164 ± 99 µm versus 226 ± 38 µm; p = 0.13). All staphylomatous regions showed a localized BM defect.
Marked scleral thinning and spatially correlated BM defects histologically characterized myopic scleral staphylomas, while thickness and density of the choriocapillaris and RPE and BM thickness did not differ significantly between staphylomatous versus non-staphylomatous eyes in the respective regions. These findings support the notion that a locally reduced scleral resistance against a backward pushing BM led to a local scleral outpouching. The outpouching-associated increase in curvature length may stretch BM with the sequel of a localized BM rupture.
尽管后巩膜葡萄肿的组织形态计量学描述是近视性黄斑病变的主要组成部分，但迄今为止相关报道较少，我们对摘除的人眼巩膜葡萄肿进行了组织形态计量学研究。
我们使用光学显微镜对因恶性脉络膜黑色素瘤或继发性闭角型青光眼而摘除的人眼球矢状组织切片进行了组织形态计量学检查。
在纳入研究的246只眼球中，10只眼检测到后巩膜葡萄肿（平均长度：31.4 ± 3.0 mm；范围：28.0 - 37.0 mm）。与根据年龄和眼轴长度调整后的对照组相应区域相比，研究组葡萄肿区域的巩膜厚度显著降低（109 ± 25 µm对319 ± 161 µm；p = 0.001）。研究组葡萄肿区域与高度近视对照组相应区域相比，视网膜色素上皮（RPE）细胞密度（19.6 ± 4.9个细胞/300 µm对21.1 ± 5.7个细胞/300 µm；p = 0.84）、RPE高度（8.2 ± 2.8 µm对6.1 ± 2.5 µm；p = 0.13）、布鲁赫膜（BM）厚度（3.5 ± 1.3 µm对4.2 ± 2.3 µm；p = 0.40）、脉络膜毛细血管厚度（5.3 ± 2.8 µm对4.4 ± 2.8 µm；p = 0.49）和密度（164 ± 99 µm对226 ± 38 µm；p = 0.13）均无显著差异。所有葡萄肿区域均显示局部BM缺损。
明显的巩膜变薄和与空间相关的BM缺损是近视性巩膜葡萄肿的组织学特征，而脉络膜毛细血管、RPE的厚度和密度以及BM厚度在葡萄肿眼与非葡萄肿眼的相应区域之间无显著差异。这些发现支持了这样一种观点，即局部巩膜对向后推挤的BM的抵抗力降低导致局部巩膜膨出。膨出相关的曲率长度增加可能会拉伸BM，继而导致局部BM破裂。
