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Laith Kadasi, Nora V Laver, Kara Lombardo, Nelli Lakis, Michael Migliori; Evisceration and Sympathetic Ophthalmia: Histopathology and PCR analysis of the scleral bed. Invest. Ophthalmol. Vis. Sci. 2018;59(9):112.
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© ARVO (1962-2015); The Authors (2016-present)
The primary aims of this study are to directly visualize the scleral bed in eviscerated eyes receiving either absolute alcohol or hydrogen peroxide based evisceration surgery, and to explore the antigenic postoperative environment with a specific focus on previously identified immune targets associated with the development of sympathetic ophthalmia. The secondary aim of the study is to propose new surgical guidelines to reduce potentially exacerbating factors to the immune response cascade in the postoperative period.
Fifty families and next of kin were contacted to discuss and offer inclusion in the study with 16 subjects recruited from Rhode Island Hospital from May 2016 to July 2017. Evisceration surgery was performed on 32 eyes in postmortem subjects using one of three methods: scleral shell washout with normal saline (n=16), dehydrated isopropyl alcohol (n=8), or hydrogen peroxide (n=8). Formalin fixed, paraffin embedded (FFPE) sections of the scleral bed sectioned at 4 microns were stained with hematoxylin and eosin (H+E) for light microscopy visualization. Quantitative real-time polymerase chain reaction antigenic analysis (RT-qPCR) was used to quantify mRNA levels of retinal S antigen and retinol binding protein 3.
Light microscopy analysis revealed 4 of 32 (12.5%) specimens to contain fragments of uveal tissue adherent to the scleral bed following evisceration surgery. No uveal remnants were noted in the hydrogen peroxide treatment group, however all specimens in this group were found to have significant cytoarchitecture disruption with decreased collagen density. No statistically significant difference in Retinol-binding protein 3 or retinal S antigen were found between surgical protocol groups on RT-qPCR analysis.
No statistically significant difference in residual antigenic deposits were found between control eyes and eyes treated with denaturing compounds during evisceration washout. Despite these findings, evisceration surgery results in a significant burden of uveal remnants postoperatively, which remain embedded within the scleral shell. Although the burden of postoperative uveal remnants may be reduced when using alternative protocols such as 3% hydrogen-peroxide-based evisceration surgery, the authors recommend against the use of intraocular peroxide at this concentration due to destructive changes noted on light microscopy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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