Nork T M, Millecchia L L, Strickland B D, Linberg J V, Chao G M
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA.
Arch Ophthalmol. 1995 Aug;113(8):1066-73. doi: 10.1001/archopht.1995.01100080118039.
To determine if there are histopathologic changes in the outer retina that could explain the blue-yellow color confusion previously described following rhegmatogenous retinal detachment in humans.
Ten eyes with traumatic retinal detachments were studied. Eight of the eyes were removed from 2 1/2 to 11 days following trauma. In the remaining two eyes, the retinas were successfully reattached. Enzyme histochemical studies for carbonic anhydrase and immunochemical studies for S antigen were performed to distinguish blue cones from red/green cones.
With the 2 1/2- to 4-day-old detachments, nearly all of the carbonic anhydrase-negative (blue-sensitive) cones and many of the rods were seen to have signs of irreversible necrosis, including extreme swelling of the inner segments and mitochondria, loss of the outer segments, and pyknotic and displaced nuclei. In the 6- and 11-day-old detachments, almost all of the carbonic anhydrase-negative cones and many rods were missing. Blue cones were essentially absent from the reattached retinas, and there were only about half the normal number of rods.
Rhegmatogenous retinal detachment results in rapid and almost total loss of the blue cones. Significant rod loss also occurs in this type of detachment but the red/green cones are comparatively resistant to damage. These findings could explain the observed blue-yellow color confusion in such patients. We discuss other clinical implications.
确定视网膜外层是否存在组织病理学改变，以解释人类孔源性视网膜脱离后先前描述的蓝黄色色觉混淆现象。
对10只外伤性视网膜脱离眼进行研究。其中8只眼在受伤后2.5至11天摘除。其余2只眼视网膜成功复位。进行碳酸酐酶的酶组织化学研究和S抗原的免疫化学研究，以区分蓝色视锥细胞与红/绿色视锥细胞。
在脱离2.5至4天的眼中，几乎所有碳酸酐酶阴性（对蓝色敏感）的视锥细胞和许多视杆细胞都出现了不可逆坏死的迹象，包括内节和线粒体极度肿胀、外节缺失以及核固缩和核移位。在脱离6天和11天的眼中，几乎所有碳酸酐酶阴性视锥细胞和许多视杆细胞都消失了。复位后的视网膜中基本没有蓝色视锥细胞，视杆细胞数量仅约为正常数量的一半。
孔源性视网膜脱离导致蓝色视锥细胞迅速且几乎完全丧失。在这种类型的脱离中也会发生明显的视杆细胞丢失，但红/绿色视锥细胞相对抗损伤。这些发现可以解释此类患者中观察到的蓝黄色色觉混淆现象。我们讨论了其他临床意义。
