出血性老年性黄斑变性的病理组织观察  

Histopathology observation of hemorrhagic age-related macular degeneration

作　　者：韩亮[1] 马志中[1] 

机构地区：[1]北京大学第三医院眼科中心视觉损伤与修复教育部重点实验室, 100191

出　　处：《中华眼底病杂志》2013年第4期372-375,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察出血性老年性黄斑变性（AMD）的病理组织特点。方法手术中获取的36例出血性AMD患者的石蜡标本纳入研究。患者中，隐匿性脉络膜新生血管（CNV）26例；息肉样脉络膜血管病变（PCV）10例。病理标本常规处理后行苏木精一伊红、糖原法、Masson染色。光学显微镜观察。在最大垂直和水平的病理标本切片上，记录细胞及细胞外基质中细胞的组成种类，以及病理组织与视网膜和脉络膜的位置关系。依据病变组织组成不同分为新生血管为主型、胶原纤维为主型、出血后的红细胞聚集为主型、变性增厚的Bruch膜为主型。结果36例患者中，新生血管为主型19例，其中隐匿性CNV18例，PCV1例；胶原纤维为主型6例，均为隐匿性CNV；出血后红细胞聚集为主型8例，其中隐匿性cNV1例，PCV7例；变性增厚的Bruch膜为主型3例．其中隐匿性CNV1例，PCV2例。以新生血管为主型的隐匿性CNV，病变组织血管管径细小，血管内径为单层内皮细胞附着，并伴有血管内、外红细胞聚集；以新生血管为主型的PCV病变组织位于Bruch膜下，血管管径粗大，血管壁厚，可见脉络膜黑色素细胞。视网膜色素上皮细胞散在分布于所有标本中，且以偏向视网膜方向为主。5份标本新生血管附近可见大量炎性细胞存在。结论出血性AMD组织结构呈多样性。Ovjective To observe the surgically excised specimens from eyes with hemorrhagic age- related macular degeneration （AMD）. Methods Thirty-six surgically excised specimens were captured from 36 patients with hemorrhagic AMD, 26 specimens were diagnosed as occult choroidal neovascular membrane （CNVM）, 10 specimens were diagnosed as polypoidal choroidal vasculopathy （PCV）. All specimens were routinely processed by hematoxylin and eosin, periodic acid-Schiff＇s stain and Masson stainings. At the maximum horizontal and vertical slice of the specimens, the category and amount of the cells in the specimen were recorded, as well as the relationship between the specimens and the surrounding tissue. Results The 36 specimens are categorized as neovascular membrane dominant （19/36）, collagen fiber dominant （6/36）, blood clot dominant （8/36） and degenerated thickened Brueh＇s membrane dominant （3/36）. Eighteen occult CNVM specimens and 1 PCV specimen are categorized as neovascular membrane dominant; all 6 collagen fiber dominant specimens are occult CNVM; 1 occult CNVM and 7 PCV specimens are categorized as blood clot dominant~ and 1 occult CNVM and 2 PCV specimens are categorized as degenerated thickened Bruch＇s membrane dominant. The occult CNVM categorized as neovascular membrane dominant present as small blood vessel with single endothelium cell attached; the PCV specimen categorized as neovascular dominant presents as big blood vessel with thick vessel wall under the Bruch＇s membrane, retinal pigment epithelium and choroidal melanocyte are both observed in the PCV specimens. Conclusion The components of the specimens captured from eves with hemorrhagic AMD are diversified.

关 键 词：黄斑变性 病理学 脉络膜疾病 病理学 视网膜新生血管化 病理学 

分 类 号：R77[医药卫生—眼科]