매우 광범위한 허혈성 증식당뇨망막병증에서 급속히 증식하는 망막전막의 미세구조
Ultrastructure of Rapidly Proliferating Preretinal Membrane of Very Extensive Ischemic Diabetic Retinopathy
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목적: 혈당조절이 불량한 젊은 당뇨환자들이 심한 허혈성 증식당뇨망막병증이 있어 철저한 내과적 관리 및 성공적인 망막수술에도 불구하고 병의 예후가 매우 나쁜 경우가 있다. 이들 환자에서 급속히 증식하는 망막전막의 조직학적 소견을 알아보고자 하였다. 대상과 방법: 젊은 나이에 혈당조절이 불량하고, 안저 전체에 매우 심한 모세혈관비관류가 생겨 있는 심한 허혈성 증식당뇨망막병증으 로 급속히 진행하여 성공적인 유리체절제술을 받았지만, 예후가 좋지 않았던 환자 5명(6안) (평균나이 35.3세)을 대상으로 하였다. 수 술 시 채취한 9건의 망막전막을 3% glutaraldehyde 용액에 고정 후 주사전자현미경으로 관찰하였다. 결과: 모든 경우에서 매우 활동적인 섬유아 형상의 세포들과 함께 신생혈관 생성을 관찰할 수 있었다. 신생혈관주위의 세포들은 세포질 내 큰 핵과 뭉쳐 있는 염색질, 세포분열 등 활동적인 모습을 보였다. 그 외 다양한 발생단계의 혈관들과 함께 매우 활동적인 세포들이 관찰되었다. 결론: 젊은 나이의 매우 심한 허혈성 증식당뇨망막병증을 대상으로 처음 발표되는 병리조직학적 보고로 일반 당뇨망막병증과 달리 급속히 증식하며 예후가 나쁠 수도 있다는 것을 뒷받침한다.
Abstract
Purpose: Using transmission electron microscopy (TEM), we studied the ultrastructures of rapidly proliferating preretinal membranes of young patients with very extensive ischemic proliferative diabetic retinopathy and diabetes with uncontrollable blood sugar level. Methods: Nine cases of preretinal membranes were obtained from six eyes of five patients with rapidly progressed proliferative diabetic retinopathy (mean age, 35 years) during vitrectomy. We obtained each preretinal membrane bimanually as one single sheet membrane using intraocular scissors and forceps. Each tissue was fixed in 3% glutaraldehyde in the operating room. All specimens were prepared and studied using TEM. Results: The preretinal membranes were composed of blood vessels and some interstitial cells. The blood vessels within the preretinal membranes varied in developmental stages, from the immature stage to the mature stage. The blood vessels were highly active, in that primitive cells showed a large nucleus and prominent chromatin clumping with abundant cytoplasm. Highly active fibroblast-like cells were also noted. Conclusions: We observed highly active angiogenesis in preretinal membranes, which rapidly proliferated in cases of severe retinal ischemia in young diabetes patients. This is the first report of such a finding, which may help to explain the poor prognosis of this disease modality.
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