Apoptotic photoreceptor cell death after traumatic retinal detachment in humans
C. J. Chang, W. W. Lai, D. P. Edward and M. O. Tso
Department of Ophthalmology, Tri-service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
OBJECTIVE: To determine the mechanism of photoreceptor cell death after
traumatic retinal detachment in humans. DESIGN: Clinical records from 1975
to 1993 of 75 patients, whose eyes were enucleated after traumatic retinal
detachment, were reviewed for age, sex, previous ocular or systemic medical
history, interval from initial trauma to enucleation, visual acuity, and
types of trauma. The patients were divided into five groups of 15 cases
each, based on the interval from initial trauma to enucleation. The retinal
tissue was examined for two markers of apoptosis: (1) nicked nuclear DNA in
situ by the terminal deoxynucleotidyl transferase-mediated biotinylated
deoxyuridine triphosphate nick end labeling (TUNEL) technique and (2)
apoptotic bodies by light and electron microscopy. RESULTS: Of the 75 cases
of ruptured globe and traumatic retinal detachment that were evaluated, 19
eyes (25.3%) showed TUNEL-positive labeling of photoreceptor cells. Nicked
nuclear DNA was detected in photoreceptor cells of detached retinas as
early as 8 hours after trauma. The detached retinas in seven of 15 eyes
enucleated within 2 days after ocular trauma showed TUNEL-positive
photoreceptor nuclei. The number of cases showing TUNEL-positive
photoreceptor nuclei decreased as the interval between initial trauma and
enucleation increased. The TUNEL-positive photoreceptor cells could still
be seen in the detached retinas of two eyes enucleated 22 days after
trauma. Light microscopy disclosed condensation and fragmentation of
photoreceptor nuclei in the detached retinas. Electron microscopy showed
structures resembling apoptotic bodies phagocytosed by neighboring cells in
the TUNEL-positive retinas. CONCLUSIONS: Apoptosis is an important
mechanism of photoreceptor cell degeneration in the early stage after
traumatic retinal detachment in humans.
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