Ocular Cytopathology

An atlas that features the cytologic findings of the normal features and diseases of the eye.

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Thursday, September 29, 2005

Amyloidosis, Silicone Vitreoretinopathy, pg2


Vitreous amyloidosis is usually associated with primary familial amyloidosis. It is important to recognize vitreous amyloidosis because it may be the presenting sign or symptom of both systemic and ocular lesions, including proptosis, ocular palsies, internal ophthalmoplegia, neuroparalytic keratitis, glaucoma, and conjunctival involvement. [18, 19, 20, 21, 22, 23, 24]
Amyloidosis in the vitreous is causally linked with retinal blood vessel involvement. Vitreous amyloid may be dense enough to obscure vision or may be misinterpreted clinically as vitreous hemorrhage. [25] Biomicroscopically, the opacities may appear yellow-white and have a membranous veil-like quality (Figure 6-7). Some authors have described a central white dot associated with vertically oriented yellow strands. [26]
Vitrectomy may be done as a diagnostic or therapeutic maneuver. [27, 28, 29, 30] Intraocular washings reveal amorphous birefringent deposits that are enhanced with Congo red stain (Figure 6-8). Red-green dichroism may be observed in specimens stained with Congo red and illuminated with polarized light (Figure 6-9). Amyloid fluoresces with thioflavin T stain. It has been demonstrated that vitreous amyloid reacts immunocytochemically with antibody to prealbumin. [31] Familial amyloidosis of the neuropathic type has been associated with homozygosity for the transthyretin methionine-30 gene. [32]


Silicone oil is used retinal detachment surgery as a means to tamponade retinal breaks and reattach the retina. [33, 34, 35] It is often reserved for cases of recurrent retinal detachments and advanced proliferative vitreoretinopathy. [36] There is experimental and clinical evidence to suggest that silicone oil may stimulate fibrous proliferation and recurrent membrane formation. [37, 38, 39, 40] Histologic studies have demonstrated glial or pigment epithelial tissue containing vacuoles as well as extracellular clear spaces. [41] Cytologic preparations show intracellular vacuoles that presumably represent silicone oil engulfed by glial cells and macrophages (Figure 6-10).


The differential diagnosis of clear vacuoles within macrophages includes residual healon (hyaluronic acid polymer). This viscoelastic substance is used mainly during cataract surgery to keep the ocular chambers formed so instruments glide smoothly through incisions and the corneal endothelium is protected from damage. Cytologic specimens show macrophages with cytoplasmic clear spaces (Figure 6-11). A proliferative reaction has not been reported with healon.

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