STUDIES OF THE RETINAL CAPILLARIES IN RELATION TO DIABETIC AND OTHER RETINOPATHIES.
STUDIES OF THE RETINAL CAPILLARIES IN RELATION TO DIABETIC AND OTHER RETINOPATHIES.
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DOI：
10.1136/bjo.47.9.521
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发表时间：
1963-09-01
期刊：
影响因子：
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通讯作者：
ASHTON, N
中科院分区：
文献类型：
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作者：
ASHTON, N
仅十年前，关于糖尿病视网膜病变问题的实验室研究还仅限于在孤立的眼科中心工作的少数研究人员，但如今，它引起了许多不同方面的广泛关注，文献充满了新的观察结果和新的理论。因此，现在是时候考虑这种疾病的各种病理特征在多大程度上可能是糖尿病特有的，或者仅仅是对非特异性损伤的基本反应。我想回顾一下我自己和其他实验室最近的一些发现，这些发现进一步阐明了视网膜毛细血管的正常和异常反应，并讨论它们与糖尿病视网膜病变的病理学图像和一些已提出的发病机理理论的可能关系。三个最重要的表现将被讨论，即内皮细胞增生，毛细血管微动脉瘤，毛细血管关闭。静脉扩张的问题是一个临床问题，关于它是糖尿病视网膜病变的早期症状，目前还没有完全一致的意见，因此我不把它作为一个病理实体来处理。每个人都肯定会同意，渗出物只是次要的。在讨论这三种病理表现之前，先对我们的技术方法和正常视网膜毛细血管作一些评论。方法注射技术和特殊染色方法在研究视网膜血管的正常和病变解剖中具有重要价值，特别是当所发现的结果与从视网膜分离的血管的制备有关时。注射尤其提供了毛细血管闭合的程度和分布的有价值的证据，这是糖尿病视网膜病变的一个病理方面，但一直被忽视。在我的实验室对眼循环的研究中，过去通过搅动未固定的组织将血管从视网膜上分离出来，我们称之为”摇动”制备（Ashton，1949）。用酸和碱腐蚀分离视网膜血管的氯丁橡胶模型，用胃蛋白酶和胰蛋白酶消化组织的原始技术将Schlemm管、视网膜和脉络膜血管模型的组织分离（Ashton，1951 a; 1952; 1953; Ashton和Smith，1953; Wybar，1954 a，B）。然而，直到最近才认识到，视网膜血管本身是
ONLY 10 years ago laboratory research on the problem of diabetic retinopathy was confined to a few investigators working in isolated ophthalmological centres, but to-day it is attracting widespread attentionfrom many different quarters and the literature is alive with new observations and new theories. It is therefore timely to consider to whatextent the various pathological features of the disease may be specific for diabetes or simply fundamental reactions to non-specific injury. I should liketo consider some recent findings from my own and other laboratories which throw further light on normal and abnormal reactions of retinal capillaries, and to discuss their possible relation to the pathological picture of diabetic retinopathy and to some of the theories of pathogenesis which have been advanced. Three of its most important manifestations will be discussed, namely endothelial proliferation, capillary microaneurysms, and capillary closure. The question of venous dilatation is a clinical one, and there is still not complete agreement that it is an early sign of diabetic retinopathy, and I shall not therefore deal with it as a pathological entity. Everyone would surely agree that the exudates are of only secondary importance. Before discussing these three pathological manifestations, a fewcomments will be made on our technical methods and upon the normal retinal capillaries. MethodsInjection techniques and special staining methods are of great value in studying the normal and morbid anatomy of the retinal vessels, especially when the findings are considered in relation to preparations in which the vessels have been isolated from the retina. Injection particularly provides valuable evidence of the extent and distribution of capillary closure-a pathological aspect of diabetic retinopathy which has been much neglected. In studies of the ocular circulation in my laboratory, vessels have been isolated in the past from the retina by agitation of the unfixed tissue-these we called" shake" preparations (Ashton, 1949). Neoprene casts ofretinal vessels were separated by corrosion with acids and alkalis, and casts of Schlemm's canal, of the retina, and of choroidal vessels were freed of tissue by an original technique wherein the tissues were digested with pepsin and trypsin (Ashton, 1951a; 1952; 1953; Ashton and Smith, 1953; Wybar, 1954a, b). It has only recently been recognized, however, that the retinal vessels themselves are