April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Histopathologic Reappraisal of the Early Diabetic Retinopathy
Author Affiliations & Notes
  • J. Feher
    Department of Ophthalmology and Visual Science,
    Sapienza University of Rome, Rome, Italy
  • I. Kovacs
    Department of Ophthalmology, Semmelweis University of Budapest, Budapest, Hungary
  • M. Artico
    Department of Anatomy, Faculty of Pharmacy, Sapienza University of Rome, Rome, Italy
  • M. Mancone
    Department of Cardiology and Respiratory Science,
    Sapienza University of Rome, Rome, Italy
  • S. Keresz
    Ophthalmic Neuroscience Program, Nutripharma Hungaria Ltd, Budapest, Hungary
  • C. Balacco Gabrieli
    Department of Ophthalmology and Visual Science,
    Sapienza University of Rome, Rome, Italy
  • Footnotes
    Commercial Relationships  J. Feher, None; I. Kovacs, None; M. Artico, None; M. Mancone, None; S. Keresz, None; C. Balacco Gabrieli, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 5371. doi:
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      J. Feher, I. Kovacs, M. Artico, M. Mancone, S. Keresz, C. Balacco Gabrieli; Histopathologic Reappraisal of the Early Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5371.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : Current concept on the diabetic retinopathy assigned a primary role to the endothelial dysfunction responsible for basement membrane thickening, while retinal alterations are considered to be secondary due to either ischemia or exudation. Although type 2 diabetes almost always associated with abnormal lipid metabolism, the role of this latter has not yet been studied. The aim of this study was to reveal initial retinal alterations in type 2 diabetes without or with dyslipidemia

Methods: : TEM and SEM as well as histochemical studies were performed on 46 enucleated human eyes (23 diabetics and 23 age matched controls). Morphometric studies on the capillary wall and on the inner limiting membrane (ILM) were also performed.

Results: : (i) In normal young eyes the capillary wall contains three distinct layers: the inner layer belongs to endothelial cells, the central surrounds pericytes, and the outer layer belongs to the Muller cells.(ii) In early diabetes basement membrane thickening starts at the glial side but not at the endothelial side.Highly electron-dense lysosomes accumulated in the Muller cell cytoplasm which surrounded the retinal capillaries. Proliferation of basement membrane material was also observed in the intercellular space of the Muller cell next to the capillaries.(iii) In the thickened outer layer lipids were accumulated in various extents, but it was particularly evident in diabetic patients with dyslipidemia(iv) The ILM was also thickened and vacuolated.(v) Both capillary wall and ILM thickening was significantly higher in diabetics as compared to age matched controls (p<0.01),(vi) Histochemistry showed accumulation of type II (vitreal/glial) collagen in both localization.

Conclusions: : Our study on early diabetic retina added three significant new findings to the current concept:(i) Muller cells initiate to deposit excessive basement membrane material,(ii) Dyslipidemia is a contributing factor to diabetic retinopathy(ii) ILM may have alterations similar to those of the capillary wall.These observations suggested that changes of Muller cell metabolism rather than those of endothelial cells may play primary role in early diabetic retinopathy. Furthermore, metabolic syndrome pathologic point of view has a specific feature, i.e. metabolic retinopathy.

Keywords: diabetic retinopathy • microscopy: electron microscopy • metabolism 

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