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M. A. Veckeneer, E. Van Aken, R. Cornelissen, L. Derycke; Persistent Foveal Blebs: Are They Related to the Schwartz-Matsuo Syndrome?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4704.
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© ARVO (1962-2015); The Authors (2016-present)
In the Schwartz-Matsuo syndrome photoreceptor fragments (PRF) clog the trabecular meshwork causing ocular hypertension in longstanding retinal detachments. Could persistent foveal blebs occur as a result of clogging of the retinal pigment epithelial barrier? In order to test this hypothesis, we studied the cellular content of subretinal fluid from eyes with a persistent foveal bleb after successful primary rhegmatogenous retinal detachment (RRD) repair.
Samples of subretinal fluid were collected at the time of surgery for RRD with detached macula. A sharp 27 gauge needle connected to a 3cc syringe without plunger was used to drain subretinal fluid transsclerally. 19 samples from 19 cases were collected. 9 samples were stored at 4°C and totally cytospinned before anti-rhodopsin immunostaining was performed. 10 other samples were fixed immediately in 2% glutaraldehyde and further analysed with electron microscopy. The macular area of the operated eye was studied using OCT stratus 4 weeks post surgery.
Anti-Rhodopsin immunostaining: Three out of nine samples were graded as highly cellular with cell counts of 7304/mm2, 20 271/mm2 and 9092/mm2 respectively. The cells were predominantly rhodopsin positive in all three samples (85.7%, 86.8% and 95.1% respectively). Six out of nine samples contained less than 1500 cells/mm2 and were scored as scantily cellular.Electron microscopy: After centrifugation and osmium tetroxide treatment, only 3/10 samples contained cells on light microscopy and were therefore retained for further processing for electron microscopy. One sample contained only retinal pigment epithelial cells, one sample contained a mixture of retinal pigment epithelial cells, red blood cells and photoreceptors, and one sample contained nearly only photoreceptors. Postoperative OCT scans demonstrated persistent subretinal fluid in those eyes corresponding to the highly cellular samples that immunostained positive for rhodopsin. OCT’s from eyes with scantily cellular subretinal fluid were graded normal.
High cellular content is observed in cases with persistent foveal bleb. Immunostaining and electron microscopy confirm the dominance of photoreceptors and or photoreceptor fragments. A relationship with the persistence of subretinal fluid may be suggested by these findings but larger numbers need to be investigated to confirm this hypothesis.
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