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黄斑及旁中心凹区的玻璃膜疣。

Drusen in the macula and parapapillary region.

机构信息

Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2024 Aug;262(8):2503-2513. doi: 10.1007/s00417-024-06438-5. Epub 2024 Mar 13.

Abstract

PURPOSE

To examine histological characteristics and differences between drusen beneath the retinal pigment epithelium (small hard drusen) located in the macula and located in the parapapillary region.

METHODS

We histomorphometrically examined human eyes enucleated due to uveal melanomas or secondary angle-closure glaucoma.

RESULTS

The study included 106 eyes (age, 62.6 ± 15.2 years) with macular drusen (n = 7 globes) or parapapillary drusen (n = 29 eyes) and 70 eyes without drusen. In all drusen, periodic-acid-Schiff-positive material was located between the RPE basal membrane and the inner collagenous layer of Bruch's membrane (BM). Macular drusen as compared with parapapillary drusen had lower height (15.2 ± 10.1 µm versus 34.3 ± 19.8 µm; P = 0.003), while both groups did not differ significantly in basal drusen width (74.0 ± 36.3 µm versus 108.7 ± 101.0 µm; P = 0.95). Eyes with macular drusen and eyes without drusen did not differ significantly in BM thickness (2.74 ± 0.44 µm versus 2.55 ± 0.88 µm; P = 0.57) or in RPE cell density (35.4 ± 10.4 cells/480 µm versus 32.8 ± 7.5 cells/480 µm; P = 0.53), neither in the drusen region nor in the drusen vicinity, while BM thickness (4.60 ± 1.490 µm; P < 0.001) and RPE cell density (56.9 ± 26.8 cells/480 µm; P = 0.005) were higher at the parapapillary drusen. Eyes with macular drusen, eyes with parapapillary drusen, and eyes without drusen did not differ significantly in choriocapillaris density (all P > 0.10) and thickness (all P > 0.35). Limitations of the study, among others, were a small number and size of drusen examined, diseases leading to enucleation, lack of serial sections, limited resolution of light microscopy, and enucleation-related and histological preparation-associated artefacts.

CONCLUSIONS

The findings of this study, also taking into account its methodological limitations, suggest that macular drusen and parapapillary drusen shared the morphological feature of periodic-acid-Schiff-positive material between the RPE basal membrane and BM and that they did not vary significantly in choriocapillaris thickness and density. RPE cell density and BM thickness were higher in parapapillary drusen than in macular drusen.

摘要

目的

观察位于视网膜色素上皮(小硬性玻璃膜疣)下的黄斑区和视盘旁区的玻璃膜疣的组织学特征和差异。

方法

我们对因脉络膜黑色素瘤或继发性闭角型青光眼而摘除眼球的人眼进行了组织形态计量学检查。

结果

该研究共纳入 106 只眼(年龄 62.6±15.2 岁),包括黄斑区玻璃膜疣(n=7 只眼)或视盘旁玻璃膜疣(n=29 只眼)和 70 只无玻璃膜疣的眼。在所有玻璃膜疣中,过碘酸雪夫(Periodic-acid-Schiff,PAS)阳性物质位于 RPE 基底层和布鲁赫膜(Bruch's membrane,BM)内层胶原之间。与视盘旁玻璃膜疣相比,黄斑区玻璃膜疣的高度较低(15.2±10.1μm 与 34.3±19.8μm;P=0.003),但两组在基底玻璃膜疣宽度上无显著差异(74.0±36.3μm 与 108.7±101.0μm;P=0.95)。有黄斑玻璃膜疣的眼与无玻璃膜疣的眼在 BM 厚度(2.74±0.44μm 与 2.55±0.88μm;P=0.57)或 RPE 细胞密度(35.4±10.4 个细胞/480μm 与 32.8±7.5 个细胞/480μm;P=0.53)方面无显著差异,无论是在玻璃膜疣区域还是在玻璃膜疣附近,而 BM 厚度(4.60±1.490μm;P<0.001)和 RPE 细胞密度(56.9±26.8 个细胞/480μm;P=0.005)在视盘旁玻璃膜疣处更高。有黄斑玻璃膜疣的眼、有视盘旁玻璃膜疣的眼和无玻璃膜疣的眼在脉络膜毛细血管密度(均 P>0.10)和厚度(均 P>0.35)方面无显著差异。该研究的局限性还包括检查的玻璃膜疣数量和大小较小、导致眼球摘除的疾病、缺乏连续切片、光镜分辨率有限以及眼球摘除相关和组织学制备相关的人为因素。

结论

本研究的结果,同时考虑到其方法学的局限性,表明黄斑玻璃膜疣和视盘旁玻璃膜疣在 RPE 基底层和 BM 之间具有 PAS 阳性物质的形态特征,并且它们在脉络膜毛细血管厚度和密度方面没有显著差异。视盘旁玻璃膜疣的 RPE 细胞密度和 BM 厚度高于黄斑玻璃膜疣。

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