Indian Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 1990  |  Volume : 38  |  Issue : 2  |  Page : 74--77

Elastic fibres in retinal detachment


Rajvardhan Azad 
 Dr Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. Ansari nagar, New Delhi- 110 029, India

Correspondence Address:
Rajvardhan Azad
Dr Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S. Ansari nagar, New Delhi- 110 029
India

Abstract

Generalised abnormalities have been described previously in familial and bilateral retinal detachment 1.2.3. Some studies have shown the presence of specific histological skin changes in cases of retinal detachment per se as well as in other syndromes having associated retinal detachment, hence pointing towards a generalised abnormality of constitution3.9.12. Drawing an analogy from these observations, the aim of our study was to study the histological changes in the skin of patients with rhegmatogenous retinal detachment and to relate its a etiopathogenesis to a generalized abnormality.



How to cite this article:
Azad R. Elastic fibres in retinal detachment.Indian J Ophthalmol 1990;38:74-77


How to cite this URL:
Azad R. Elastic fibres in retinal detachment. Indian J Ophthalmol [serial online] 1990 [cited 2020 Apr 9 ];38:74-77
Available from: http://www.ijo.in/text.asp?1990/38/2/74/24541


Full Text

 METHODS



Skin as well as muscle biopsies were taken from twenty consecutive cases of rhegmatogenous retinal detach­ment (14 males and 16 males) between the age group of 16-69 years. Twenty age and sex matched healthy controls also underwent similar investigations. The skin biopsy in all the cases was taken from the junction of the upper one-third and lower two-third of the posterior portion of the right leg. Muscle biopsy was simul­taneously taken from the gastrocnemius muscle. Both skin and muscle tissues were fixed in 10% neutral buffered formalin. Paraffin sections from both the tis­sues were stained by Hematoxylin-eosin ( H & E), Van­ Gieson (VG), Verhoeff's iron hematoxylin (VIH) and colloidal iron (CI) stains.

Evaluation and examination of the biopsied tissues was undertaken keeping in view following parameters (A) skin- (i)total thickness; (ii) epidermis-thickness, matura­tion and polarity of cells; (iii) rete ridges-present or absent: (iv) epidermal appendages - any pathologic abnormality; (v) collagen to elastic tissue ratio in the upper as well as in the deep dermis; (vi) inflammation acute or chronic; (viii) any other change in dermal blood vessels, nerves etc. (B) Skeletal muscle- (i) any change of atrophy or dystrophy (ii) inflammation - acute, chronic or granulomatous; (iii) calcification; (iv) any change in its blood vessels, or any other abnormality .

Histological findings of both skin and muscle were com­pared with age and sex matched controls.

 RESULTS



[Table 1] shows the histopathological changes in the skin of patients and controls. There were 14 males and 6 females ranging between the age group of 16-69 years. The mean value for epidermal thickness was 42 It in cases of retinal detachment and 56 11 in the control group, corresponding to a difference of 10-15 pt or 1-2 layers of cells. The thickness of dermis was difficult to measure due to great variation within the same section. In cases of retinal detachment, the mean value of dermal thickness was 1100p, the corresponding value of control group was 1500« [Figure 1] A & B.

Alterations in connective tissue were seen in 75°/h cases as indicated in [Table 1]. The mass of elastic fibres was. uniformly increased involving almost the entire dermis. [Figure 2]A & B. Elastic fibres were present in thick irregular bundles and appeared as broad, folded, stubby or clumped fibres. Thin elastic fibres were seen in continuation with greatly expanded elastic fibres [Figure 3]. On colloidal iron stain, many expanded bluish-green fibre masses were seen in reticular dermis. An internal fibrillar structure could be discerned in them along with the presence of a fine granular substance. Occasional­ly, small vacuoles could be made out in these fibre masses [Figure 4]A & B. Also, a moderately dense substance was seen1o be deposited between these masses and collagen fibres. Blood vessels in the elas­totic mass were frequently normal in appearance. Sometimes; however, the walls appeared thickened, or the vessel ectatic. Collagen fibres appeared normal in most of the areas examined. In some instances, how­ever, thick clumped collagen fibres were observed [Fig­ure 5].

In two patients, major portion of the dermis was replaced by adipose tissue which was seen to be present around the epidermal appendages also. In another two patients, although skin thickness and rete pegs were normal, disturbance of connective tissue ratio was seen.

In two controls (one 58 year old female and one 65 year old male), although connective tissue in the dermis was altered (ET : CT = 2:1), CT stain did not show any increase in ground substance or the presence of bluish green fibre masses.

 DISCUSSION



In the present study. changes in elastic fibres were seen in skin biopsies taken from unexposed portions of the body of patients with retinal detachment. Altered as well as increased elastic tissue was seen in 75° .6 of cases when compared with controls in whom collagen tissue component predominated (CT : ET = 2-3:1). This is in contrast to the others authors findings [4]. There was an active production of elastic fibres, though many were severely damaged, as was evident from their morphol­ogy. Similar morphologic changes have been described in other dermal elastotic conditions also, [6] [9] [10].The bluish green fibre masses probably represented . degraded elastic fibres. In the present material, the sequence of events appeared to be an increase in density and breadth of fibrils, increase in density of fibre matrix, disorganization of fibrils, a granular change in matrix with disorganization of fibrils, a granular change in matrix with vacuoles in disrupted fibres. The matrix substance seen in between collagen and elastic fibres seemed to be derived from degenerated elastic fibres. Similar observations have been described in other der­mal diseases also. [8],[11]

The pathological changes observed in collagenous tis­sue were minor in extent and non-specific.

Reduction of skin thickness and replacement by adipose tissue in the dermis could be due to degeneration of elastic tissue of the dermis. Reduced thickness in such cases has been observed by other authors also. [4]

Presence of increased amount of elastic tissue in two members of the control group (both above 50 years) when colloidal iron stain was negative indicated that they may be age-related. Similar findings have been observed by others [5].[7]

The above findings strengthen the thesis that like other dermal elastotic conditions which also involve the eye (Pseudoxanthoma elasticum, Ehler's Danlos syndrome), cases of idiopathic retinal detachment may also be due to an elastic tissue abnormality [9],[12].How­ever, nature of the defect, whether congenital or ac­quired, could not be determined.

References

1Edmund J. Familial retinal detachment. Acta Ophthal 39:644. 1961.
2Pemberton JW. Mackenzie Freeman H. Schapens CI. Familial retinal detachment in Ehlers Danlos Syndrome. Arch Ophthal 76: 817, 1966.
3Harvout F. Anatomie pathologique at pathogani du decollement retinien. Ophthalmologica 160:25. 1970.
4Hansen FK. Ehlers N, Bentzen 0 and Sogaad H. Central corneal thickness in retinal detachment. Acta Ophthalmol. 49:467. 1971.
5Marshall BR. The clinical and pathological effects of prolonged solar exposure 1. The association with ageing of the skin. Austr. N Z J Surg. 34:161. 1965.
6Smith JG. Lansing Al. Distribution of solar elastosis in the skin. J Geront 14:496. 1959.
7Danielson L, Kobayasi T. Degeneration of dermal elastic fibres in relation to age and light exposure. Acta dermatovener (Stock­holm) 52:1. 1972.
8Hashimoto K. Dibella RJ. Electron microscopic studies of normal and abnormal elastic fibres of the skin. J Invest Derm 48: 405. 1971.
9Smith JG. Durham NC. The dermal elastosis. Arch. Derm 88 76. 1963.
10Mitchell RE. Chronic Solar dermatosis : A light and electron microscopic study of the dermis. J Invest Derm 48:203. 1967.
11Banfield WG. Brindley DC. Preliminary observations on senile elastosis using the electron microscope. J Invest Derm 41:9. 1963.
12Scarpelli DG. Goodman RM. Observations on the fine structure of the fibroblast from a case of Ehler's Danlos syndrome with the Marfan Syndrome. J Invest Derm 50:214, 1968.