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A. Kijlstra, L. J. A. G. Ricker, R. Al Dieri, H. C. Hemker, G. J. M. Beckers, E. Pels, A. T. A. Liem, F. Hendrikse, E. C. La Heij; High Subretinal Fluid Procoagulant Activity in Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5994.
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An increased mRNA expression of genes related to blood coagulation has been demonstrated in an experimental retinal detachment model in pigs but has not yet been confirmed in human clinical specimens. We therefore investigated whether subretinal fluid and vitreous fluid collected from patients with rhegmatogenous retinal detachment (RRD) exerted any procoagulant activity.
A calibrated thrombin generation test (CAT) was utilized to investigate the thrombogenic properties of 28 subretinal fluids collected during scleral buckling surgery for RRD. Furthermore, the thrombogenic properties of vitreous fluids from RRD (n=12), macular pucker (n=5), macular hole (n=6), proliferative diabetic retinopathy (n=5) were measured and compared with eye bank eyes (n=11), which served as controls.Identification of the procoagulant activity as tissue factor was performed by using blocking studies and Western blotting.
The addition of subretinal fluid from all RRD patients (28/28, 100%) induced thrombin generation in normal and severe FXII-deficient plasma. Contrary to subretinal fluid, the addition of vitreous fluids from various ocular disorders hardly provoked thrombin generation in normal and severe FXII-deficient plasma (1/5, 20% macular pucker; 0/6, 0% macular hole; 0/5, 0% proliferative diabetic retinopathy; and 2/11, 18% eye bank eyes), whereas vitreous samples from RRD patients showed tissue factor-like activity in 4/12 (33%) cases. The procoagulant activity in subretinal fluid on the parameters of CAT (endogenous thrombin potential, peak, time to peak and lag time) was almost completely neutralized by antibodies against human tissue factor. The presence of tissue factor in subretinal fluid was confirmed using Western blotting.
Subretinal fluid from patients with RRD exerts high procoagulant activity by the action of tissue factor, whereas vitreous fluids from various other ocular conditions hardly showed any procoagulant activity.
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