pathology of the vitreous - nc state veterinary medicine · pdf file ·...
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Pathology of the Vitreous
Philippe Labelle, DVM, DACVPAntech Diagnostics
12th Biannual William Magrane Basic Science Course in Veterinary and
Comparative Ophthalmology
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General Considerations
• Vitreous is difficult to evaluate histologically
• Liquefied vitreous may not or only partially survive processing
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Asteroid Hyalosis
• Dogs +/- other species• One form of vitreal degeneration• Lipid-calcium complex• Age related and secondary to disease• Often seen with neoplasms (iridociliary
neoplasms, melanocytic neoplasms)• The exact compostion of asteroid bodies varies
between studies (Wang et al, Mol Vis 2006; Kador et al, Eye, 2008; Labruyere et al, Vet Radiol Ultrasound 2008)
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Asteroid Hyalosis
Courtesy of COPLOW
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Asteroid Hyalosis
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Asteroid Hyalosis
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Asteroid Hyalosis
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Vitreal Hemorrhage
• Normal vessels (trauma, uveitis)• Immature vessels (fibrovascular membranes,
neoplasia)• Abnormal vessels (systemic hypertension,
PHPV/PTVL)• Blood disorders (coagulopathies)
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Vitreal Hemorrhage
• Rapid fibrin clot and slow fibrinolysis• Hemolysis of red blood cells• Limited cell infiltration• Low turnover of macrophages, few
hemosiderophages
• The purpose of this measured response may be to maintain ocular immune privilege and ocular function by avoiding a marked response leading to granulation tissue formation.
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Vitreal Hemorrhage
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Vitreal Hemorrhage
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Vitreal Hemorrhage
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Canine Ocular Gliovascular Syndrome
• Intraocular hemorrhage• Retinal detachment• Fibrovascular proliferation• Glaucoma
• Aggregates of glial (GFAP positive) cells in the vitreous• Neovascular proliferation extending into the vitreous
from the retina or optic nerve head• Hyalin collagen surrounds the neovascular
proliferation.
• Treadwell et al, VO 2015, Naranjo et al, ACVO 2006; Zeiss et al, VO, 2004.
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Canine Ocular Gliovascular Syndrome
Courtesy of Dr. Carol Naranjo
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Canine Ocular Gliovascular Syndrome
Courtesy of COPLOW
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Canine Ocular Gliovascular Syndrome
Courtesy of COPLOW
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Canine Ocular Gliovascular Syndrome
Courtesy of COPLOW
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Canine Ocular Gliovascular Syndrome
Courtesy of COPLOW
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Shih Tzu Vitreoretinopathy
• Shih Tzus• Retinal detachment• Retinal tears• Fibrovascular proliferation• Glaucoma
• Cell poor collagen deposition in the vitreous• Cells in the vitreous are myofibroblasts
• Papaioannou et al, J Comp Path 2013
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Shih Tzu Vitreoretinopathy
Courtesy of COPLOWPapaioannou et al, J Comp Path 2013
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Shih Tzu Vitreoretinopathy
Courtesy of COPLOW
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Pathology of the Retina and Optic Nerve
Philippe Labelle, DVM, DACVPAntech Diagnostics
11th Biannual William Magrane Basic Science Course in Veterinary and
Comparative Ophthalmology
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Retina
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General Considerations
• Glaucoma related changes discussed elsewhere
• Minimal healing capacity
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Retinal Detachment• Potential causes
• Trauma• Inflammation• Neoplasia• Vasculopathies• Traction• Congenital lesions• Retinal degeneration• Glaucoma/buphthalmos
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Retinal Detachment• Actual causes Canine (PL database, 100 cases)
• Neoplasia 21%• Inflammation/trauma 34%• Vasculopathies/systemic hypertension 9%• Undetermined 36%
• Inflammation/trauma: 4 VKH, 3 granulomatous scleritis and 2 diabetic cataract/granulomatous endophthalmitis. 13 cases are endophthalmitis from penetrating trauma, fungal, asymmetric uveitis. 12 cases had findings/ history of trauma w/o endophtalmitis.
• 23/36 undetermined cases had severe intraocular hemorrhage and fibrovascularproliferation with the retinal detachment (“idiopathic retinal detachment”). In the other 13 cases, the significance of the retinal detachment was unclear.
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Retinal Detachment
• Actual causes Feline (PL database 50 cases)
• Neoplasia 50%• Inflammation/trauma 32%• Vasculopathies/systemic hypertension 6%• Undetermined 12%
• Inflammation/trauma: 18% with findings/ history of trauma where inflammation was not a significant component and 14% with severe inflammation (penetrating trauma, fungal, etc).
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Retinal Detachment• Material in the subretinal space (hemorrhage,
inflammation, proteinaceous, vitreous)• Hypertrophy +/- hyperplasia of the retinal pigment
epithelium (not required)• Outer retinal atrophy• Retinal tears
• Retinal tears can be identified by the presence of interrupted retinal segments with rounded edges with gliosis
• In rare cases, retinal detachment prior to the development of glaucoma can have a sparring effect on the inner retina (ieclinical glaucoma without inner retinal atrophy)
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Retinal Detachment• Not possible to accurately determine the age of the RD
• Proliferative and hypertophic changes to the RPE can be detected 24h after RD (1-3 days)
• Photoreceptor atrophy/degeneration after 1-3 days
• Early changes to the ONL are present within a few days
• Anderson IOVS 1981; Anderson IOVS 1983
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Retinal Detachment
• More severe atrophy implies chronicity (few days-1 week or more)
• RPE hypertrophy may decrease with chronic RD
• The severity, cause, nature of subretinalmaterial, etc. all likely affect the development of retinal changes
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Retinal Detachment
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Retinal Detachment
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Retinal Detachment
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Retinal Detachment
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Retinal Detachment
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Retinal tears
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Retinal Tears
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Retinal Tears
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Progressive Retinal Atrophy
• Dogs +/- cats• Inherited/presumed inherited• Clinical evaluation required for the diagnosis• Lesions in globes removed for other diseases• Histologic evaluation has limited value• The molecular work in various breeds does
not translate to specific histologic findings.
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Progressive Retinal Atrophy
• Outer retinal atrophy• May be focal-multifocal initially• Ganglion cells may “drop” in the blended nuclear
layers• Progresses to full-thickness atrophy• Complications may include retinal detachment
and cataract• Ddx include SARDS, Retinal detachment,
toxic/nutritional retinal injury.
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Progressive Retinal Atrophy
• PRA can be suggested as a dx when there is outer retinal atrophy, especially if early and multifocal
• Once there is full thickness atrophy, there are no specific features to suggest PRA vs ddx
• Cases with retinal detachment will not have features that allow a histologic dx of preceding PRA
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Progressive Retinal Atrophy
Ganglion cell
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Progressive Retinal AtrophyGanglion cell
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Sudden Acquired Retinal Degeneration Syndrome
• Dogs, clinical evaluation required for the diagnosis
• Lesions in globes removed for other diseases• Histologic evaluation has limited value• Ddx include, PRA, Retinal detachment,
toxic/nutritional retinal injury• Previous clinical diagnosis of SARDS in most
cases
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Sudden Acquired Retinal Degeneration Syndrome
• Outer retinal atrophy, diffuse in early stages• Progresses to full-thickness atrophy• +/- minimal lymphoplasmacytic inflammation • With full thickness atrophy, there are no specific
features to suggest SARDS vs ddx• Histologic evaluation offers no insight on the possible
association with systemic/hormonal disease
• Keller et al. VO 2006; Carter et al. JAAHA 2009; Stuckey et al JAVMA 2013; Komaromy AM et al, VO 2015 [Epub ahead of print]; Heller AR et al, VO 2016 [Epub ahead of print].
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Sudden Acquired Retinal Degeneration Syndrome
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Sudden Acquired Retinal Degeneration Syndrome
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Fluoroquinolone-Induced Retinal Toxicity
• Cats• Acute• Rare/unlikely to be examined histologically• The lesions do not occur at recommended doses
in normal cats• Photoreceptor loss
• Gelatt KN et al, VO 2001; Weibe V et al, JAVMA 2002• Ramirez Pharmacogenet Genomics 2011.• Rampal S et al Hum Exp Toxicol 2008 (ofloxacin rabbits)
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Fluoroquinolone-Induced Retinal Toxicity
Courtesy of COPLOW
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Systemic Hypertension
• Usually bilateral, asymmetrical• Vessels of the retina, choroid, rarely iris• Arterioles have hyaline thickened walls and
narrowed lumen (“fibrinoid necrosis”)• PAS staining can help visualize the vascular
changes• Retinal detachment, hemorrhage and necrosis• Rarely optic nerve lesions• Intraocular hemorrhage, fibrovascular
proliferation, glaucoma
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Systemic Hypertension
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Systemic Hypertension
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Systemic Hypertension
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Diabetic Retinopathy
• Loss of pericytes• Thickening of the basement membrane of vessels• Retinal hemorrhages• Glycemic control may protect against ganglion
cell loss in dogs• No significant proliferative component
• Herring IP et al, JVIM 2014; Howell SJ et al, Mol Vis 2013
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Diabetic Retinopathy
Courtesy of COPLOW
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Diabetic Retinopathy
Raccoon, courtesy of Dr. Chris Reilly
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Diabetic Retinopathy
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Diabetic Retinopathy vsSystemic Hypertension
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Retinal Inflammation
• Infectious retinitis (canine distemper, Toxocaracanis, Haemophilus somnus, Bovine Viral Diarrhea, Toxoplasma gondii, West Nile Virus)– As part of systemic disease
• Extension of uveitis/endophthalmitis (trauma, bacterial, fungal, Prototheca, etc)
• Perivascular lymphoplasmacytic retinitis with lymphoplasmacytic uveitis (no specific significance)
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Canine Distemper
Courtesy of COPLOW
Inclusion
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West Nile Virus
Courtesy of COPLOW
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Tapetal Sparing
• Dogs, horses, others• Dorsal retina tends to be less affected by
glaucomatous change• Tapetum not necessary• Increased susceptibility ventrally rather than
dorsal/tapetal resistance
• Beamer G et al. Vet Clin North Am Small Anim Pract 2015
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Tapetal Sparing
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Tapetal Sparing
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Retrograde atrophy
• Die-back atrophy• Loss of ganglion cells secondary to optic nerve
injury• Most commonly seen with canine orbital
meningiomas• Must be differentiated from inner retinal
atrophy/glaucoma
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Retrograde atrophy
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Peripheral Retinal Cysts
• Peripheral cystoid degeneration• Dogs• Aging change• Pathologic examination of globes does not
support the suggestion (G4) that these cysts may be clinically significant as part of retinal detachment
• Similar cystic degeneration is seen in cats and horses in the ciliary pars plana (not the retina)
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Peripheral Retinal Cysts
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Optic Nerve
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General Considerations
• Glaucoma related changes discussed elsewhere
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Trauma
• Proptosis• Necrosis/malacia• Hemorrhage• Atrophy, gliosis and fibrosis with chronicity
• Horses• Necrosis with Gitter cells• Atrophy and fibrosis with chronicity• Gitter cells may extend in the vitreous (exudative
optic neuropathy).
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Trauma
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Trauma
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Ischemic Optic Neuropathy
• Horses• Acute hypovolemia• Surgical occlusion of ext/int carotid arteries
(guttural pouch mycosis)• Edema and hemorrhage • Atrophy and fibrosis with chronicity• +/- periparillary retinal hemorrhage and
degeneration
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Ischemic Optic Neuropathy
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Ischemic Optic Neuropathy
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Optic Neuritis
• Canine distemper• Granulomatous meningoencephalitis• Tick-borne encephalitis virus• Idiopathic optic neuritis
• Unlikely to be examined histologically pre-mortem, or at all in the case of idiopathic optic neuritis.
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Optic Neuritis
Courtesy of Dr. Amber Labelle
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Proliferative Optic Neuropathy
• Older horses• Benign lesion• Proliferation of macrophages and glial cells
• Saunders Vet path 1972
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Proliferative Optic Neuropathy
From Saunders andRubin 1975
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Schnabel’s Atrophy
• Dogs• Glaucoma• Vitreous extends in the cavitated optic nerve
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Schnabel’s Atrophy
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Schnabel’s Atrophy
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Schnabel’s Atrophy
Courtesy of COPLOW
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“Optic neuroma”
• Dogs• Nodular proliferation of peripheral nerve
adjacent to the optic nerve• Associated with glaucoma• Not recognized clinically• Significance?
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“Optic neuroma”
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“Optic neuroma”