Ocular Cytopathology

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

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Friday, September 30, 2005

Diabetic Retinopathy, Coats Disease, Proliferative Vitreoretinopathy


Coats’ disease is usually unilateral and is characterized by exudative retinal detachment in young males.[19][20][21] Telangiectatic blood vessels have been identified in this disorder and presumably are the basis for the retinal exudates and exudative detachment of the retina (Figure 7-3).[22][23] Coats’ disease may produce leukocoria in children and can be confused clinically with retinoblastoma. In such cases, a fine needle aspiration may be obtained to differentiate these two entities. In addition, a vitrectomy may be employed to repair the retinal detachment.[24][25][26] In either case, the specimens are extremely hypocellular with occasional macrophages containing cytoplasmic vacuoles (Figure 7-4).[27] Histologically, there is massive subretinal exudates and retinal detachment. Telangiectasis of the retinal blood vessels or the extraretinal blood vessels can be identified (Figure 7-5).


Diabetic retinopathy is the single most common source of intraocular washing specimens processed by our cytology laboratory. Retinopathy occurs in about 70% of patients who have had diabetes mellitus beyond 20 years. Diabetic retinopathy manifests as a microangiopathy with thickening of vascular basement membrane, loss of endothelium, and degeneration of capillary pericytes.[28][29][30][31][32] In the early stages, venous dilatation, capillary microaneurysms, and exudates are observed.[33][34] Vascular disease leads to ischemia of the retina and neovascularization is stimulated (proliferative diabetic retinopathy) (Figure 7-6).[35][36] Vitrectomy may be performed in this disease for several reasons, including vitreous hemorrhage secondary to neovascularization and tractional retinal detachment with removal of fibrovascular membrane.[37][38][39]
Neovascularization is identified in vitrectomy specimens as well-defined blood vessels lined by a single layer of endothelium (Figure 7-7).


The leading cause of failure in retinal detachment surgery is proliferative vitreoretinopathy (PVR).[40][41][42][43] It is characterized by a proliferation of cellular membranes on both sides of the detached retina and in the vitreous cavity.[44] Fibrovascular proliferation that extends anterior to the posterior border of the vitreous base has been termed anterior PVR.[45] Traction induced from the membranes on the posterior lens surface, ciliary body, and iris may produce a peripheral retinal detachment.[46] Epiretinal membranes are composed of retinal pigment epithelial cells, glial cells, fibrocytes, and macrophages.[47][48][49][50][51][52][53][54][55][56] Surgically removed epiretinal membranes may be sent for cytologic examination. Cell buttons or cytospin preparations reveal a thin fragment composed of spindle cells and oval cells, some of which may contain pigment (Figure 7-8).
Epiretinal membranes composed mainly of spindle cells have been associated with photocoagulation, trauma, and inflammatory disease.[57] However, most simple epiretinal membranes are idiopathic.[58]
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25. Pe'er J. Am J Opthalmsol 1988;106:742-743.
26. Laqua H, Wessing A. Ophthalmology 1983;90:1284-1291.
27. Haik BG, Koizumi J, Smith ME, Ellsworth, RM. Am J Opthalmol 1985;100:327-328.
28. Robison WG Jr. Kador PF, Kinoshita JH. Science 1983;221:1177.
29. Kalebic T, Garbisa S, Glaser B, Liotta LA.Science 1983;221:281.
30. Kuwabara T, Cogan DG. Arch Ophthalmol 1963;69:492-502.
31. Toussaint D, Dustin P. Arch Ophthalmol 1963;70:96-108.
32. Yanoff M. N Engl J Med 1966;274:1344-1349.
33. De Venecia G, Davis M, Engerman R. Arch Ophthalmol 1976;94:1766-1773.
34. Addison DJ, Garner A, Ashton N. Br Med J 1970;1:264-266.
35. Niki T, Muraoka K, Shimizu K. Ophthalmology 1984;91:1440.
36. Miller H, Miller B, Zonis S, Nir I. Invest Ophthalmol Vis Sci 1984;25:1338-1342.
37. Thompson JT, de Bustros S, Michels RG, Rice TA. Arch Ophthalmol 1987;105:503-507.
38. Thompson JT, de Buustros Michels RG, Rice TA. Arch Ophthalmol 1987; 105:191-195.
39. Blankenship GW. St Louis: C.V. Mosby, 1989;3:515-539.
40. The Retinal Society Terminology Committee. Ophthalmology 1983;90:121-125.
41. Claes C, Freeman HM, Tolentino FI. New York: Springer-Verlag, 1988:3-11.
42. Lewis H, Aaberg TM, Abrams GW. Am J Ophthalmol 1991;111:8-14.
43. Schwartz D, De la Cruz ZC, Green WR, Michels RG. Retina 1988;8:275-281.
44. Glaser BM. Pathobiology of PVR. New York: Springer-Verlag, 1988:12-21.
45. Lewis H, Aaberg T. Am J Ophthalmol 1988; 105:277.
46. Lewis H, Abrams GW, Foos RY. Am J Ophthalmol 1987;104:614-618.
47. Machemer R, Laqua H. Am J Ophthalmol 1975;80:1-23.
48. Clarkson JG, Green WR, Massoff D. Am J Ophthalmol 1977;84:1-17.
49. Daicker B, Guggenheim R. Albrecht Von Graefes Arch Klin Exp Ophthalmol 1979;210:109-110
50. Van Horn DL, Aaberg TM, Machemer R. Am J Ophthalmol 1977;84:383-393.
51. Kampik A, Kenyon KR, Michels RG, Green WR, de Cruz ZC, Epiretinal and vitreous membranes: comparative study of 56 cases. Arch Ophthalmol 1981;198199:1445-1454.
52. Kampik A, Green WR, Michels Rg, Nase PK. Ultrastructure of progressive idiopathic epiretinal membrane removed by vitreous surgery. Am J Ophthalmol 1980:90:797-809.
53. Hiscott PS, Grierson I, McLeod D. Natural history of fibrocellular epiretinal membranes: a quanative, autoradiographic and immunohistochemical study. Br J Ophthalmol 1985;69:810-823.
54. Michels RG. A clinical and hisopathical study of epiretinal membranes affecting the macula and removed bu vitreous surgery. Trans Am Ophthalmol Soc 1982;80:580-656.
55. Foos RY. Spectrum of nonvasular proliferative extraretinopathies. In: Nicholson DH, ed. Ocular pathology update. New York: Masson Publishing, 1980:107-114.
56. Foos RY. Nonvascular proliferative extraretinopathies. Am J Ophthalmol1978;86:723-725.
57. Kampik A, Green WR, Michels RG, Rice TA. Epiretinale membranen nack photokoagulation (postkoagulative maculopathie). Ber Dtsch Ophthalmol Ges 1981;78:593-598.
58. Roth AM, Foos RY. Surface wrinking retinopath in eyes enucleated at autotopsy. Trans AM Acad Ophthalmol Otolaryngol 1971;75:1047-1058.


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