眼内炎症中视网膜和脉络膜活检的临床病理研究

Clinicopathologic study of retinal and choroidal biopsies in intraocular inflammation.

作者信息

Rutzen A R, Ortega-Larrocea G, Dugel P U, Chong L P, Lopez P F, Smith R E, Rao N A

机构信息

Doheny Eye Institute, Los Angeles, CA 90033, USA.

出版信息

Am J Ophthalmol. 1995 May;119(5):597-611. doi: 10.1016/s0002-9394(14)70218-1.

DOI:10.1016/s0002-9394(14)70218-1

PMID:7733185

Abstract

PURPOSE

We reviewed the clinical and histopathologic features of 33 intraocular tissue biopsy specimens from 32 patients and assessed the value of retinal and chorioretinal biopsies performed in patients with intraocular inflammation.

METHODS

Twenty-four endoretinal biopsies and nine chorioretinal or choroidal biopsies were performed. On the basis of clinical indications, the specimens were processed for light microscopy, electron microscopy, immunohistochemical staining, in situ DNA hybridization, and polymerase chain reaction.

RESULTS

Of the 24 endoretinal biopsy specimens, 19 were from patients with clinical signs suggestive of viral retinitis. Overall, the diagnosis of viral retinitis was suggested by electron microscopy, immunohistochemical staining, in situ DNA hybridization, or polymerase chain reaction in 53% (ten of 19) biopsies. The preoperative diagnosis was confirmed in seven of ten biopsies in cases of suspected cytomegalovirus retinitis, in one of seven biopsies in cases of suspected acute retinal necrosis, and in two of two biopsies in cases of progressive outer retinal necrosis. The remaining five endoretinal biopsies disclosed Candida in one specimen, subretinal fibrosis in one, and chronic inflammation in three. Histologic examination of the nine chorioretinal or choroidal biopsies disclosed lymphoma in two specimens, a subretinal neovascular membrane in one, uveal melanocytic proliferation in one, toxoplasmic retinochoroiditis in one, viral retinitis in one, and long-standing inflammation in three.

CONCLUSION

In select cases of intraocular inflammation, intraocular tissue biopsies may provide clinically useful information.

摘要

目的

我们回顾了32例患者的33份眼内组织活检标本的临床和组织病理学特征，并评估了对眼内炎症患者进行视网膜及脉络膜视网膜活检的价值。

方法

进行了24例视网膜内层活检和9例脉络膜视网膜或脉络膜活检。根据临床指征，对标本进行光镜、电镜、免疫组化染色、原位DNA杂交及聚合酶链反应检查。

结果

24例视网膜内层活检标本中，19例来自临床有病毒性视网膜炎体征的患者。总体而言，19份活检标本中有10份（53%）通过电镜、免疫组化染色、原位DNA杂交或聚合酶链反应提示病毒性视网膜炎诊断。在疑似巨细胞病毒性视网膜炎的病例中，10份活检标本中有7份术前诊断得到证实；在疑似急性视网膜坏死的病例中，7份活检标本中有1份得到证实；在进行性外层视网膜坏死的病例中，2份活检标本均得到证实。其余5份视网膜内层活检标本中，1份发现念珠菌，1份发现视网膜下纤维化，3份发现慢性炎症。9份脉络膜视网膜或脉络膜活检标本的组织学检查发现，2份标本为淋巴瘤，1份为视网膜下新生血管膜，1份为葡萄膜黑素细胞增生，1份为弓形虫性视网膜脉络膜炎，1份为病毒性视网膜炎，3份为长期炎症。