Dubovy S R, Guyton D L, Green W R
Eye Pathology Laboratory, Wilmer Ophthalmological Institute, Baltimore, Maryland, USA.
Retina. 1997;17(6):510-20. doi: 10.1097/00006982-199711000-00005.
To report the clinicopathologic features in the eye of a patient who sustained a traumatic chorioretinal rupture from a gunshot wound to the orbit, chorioretinitis sclopetaria, with clinical follow up of more than 20 years.
The patient was studied ophthalmoscopically and by fluorescein angiography after the trauma and was seen intermittently thereafter. The eyes were obtained postmortem; sections of the central portion of the right eye, including the macula and optic nerve head, and the inferior cap were examined by light microscopy.
Histopathologic study of the right eye showed partial loss of the nerve fiber and ganglion cell layers in the macular area, temporal peripapillary and macular loss of the photoreceptors with hypertrophy and hyperplasia of the retinal pigment epithelium, an epiretinal membrane, and three defects in Bruch's membrane. Inferiorly, there was a 5-mm defect in choroid, Bruch's membrane, and retina. These structures were replaced by a loose and dense fibrous connective tissue. The sclera and a long posterior ciliary nerve remained intact. A thin fibrovascular tissue from the choroid extended into the subretinal space where it was covered by retinal pigment epithelium and thickened basement membrane in the posterior aspect of the inferior lesion. Marked hemiatrophy of the optic nerve was present.
The clinicopathologic features of chorioretinitis sclopetaria include direct traumatic chorioretinal rupture followed by marked fibrovascular proliferation with variable replacement of choroid and retina with no retinal detachment. Posteriorly, indirect macular choroidal ruptures with hyperplasia and migration of the retinal pigment epithelium into the retina and choroid, epiretinal membrane formation, loss of photoreceptors, and marked hemiatrophy of the optic nerve were present.
报告一名因眼眶枪伤导致创伤性脉络膜视网膜破裂（即猎枪性脉络膜视网膜炎）患者眼部的临床病理特征，并进行超过20年的临床随访。
对该患者在受伤后进行了眼底镜检查和荧光素血管造影，并在此后进行了间歇性检查。患者死后获取眼球；对右眼中央部分，包括黄斑和视神经乳头，以及下方的脉络膜进行了光镜检查。
右眼的组织病理学研究显示，黄斑区神经纤维层和神经节细胞层部分缺失，颞侧视乳头周围和黄斑区光感受器缺失，视网膜色素上皮肥大和增生，形成视网膜前膜，以及布鲁赫膜有三处缺损。下方，脉络膜、布鲁赫膜和视网膜有一个5毫米的缺损。这些结构被疏松和致密的纤维结缔组织所取代。巩膜和一条长睫状后神经保持完整。脉络膜的一层薄纤维血管组织延伸至视网膜下间隙，在下方病变后部被视网膜色素上皮和增厚的基底膜覆盖。视神经存在明显的半侧萎缩。
猎枪性脉络膜视网膜炎的临床病理特征包括直接创伤性脉络膜视网膜破裂，随后是明显的纤维血管增生，脉络膜和视网膜被不同程度替代，无视网膜脱离。后部存在间接性黄斑脉络膜破裂，视网膜色素上皮增生并迁移至视网膜和脉络膜，形成视网膜前膜，光感受器缺失，以及视神经明显的半侧萎缩。
