| The normal vitreous is the highly crystal gel, which consists ofcollagen fibers and macromolecule hyaluronic acid. The water content ofhyaluronic acid is high to98%. Although vitreous itself has no bloodvessels, it is a nutrition saving storehouse and is rich for nutritivematerials. When vitreous' surrounding tissues or itself take pathologicalchanges, vitreous will become good culture media for pathogen and cells.There is a kind of disease in clinical, whose features are: due to retinitisor chorioretinopathy, or the pathogen's direct invasion to vitreous cavitythrough external injury or scalpel's cut, all of these make vitreous occurinflammatory pathological mechanism's changes and make refractingmedia emerge the different levels' opacities. These features make thefundamental examinations which are based on the pellucidum ofrefracting media, for example, fluorescence fundus angiography(FFA),optical coherence tomography(OCT), lose their meaning of auxiliarydiagnosis. So vitreous cytology is born and proved that it is verymeaningful to auxiliary and excluded diagnosis of these diseases, whichare difficult to diagnose clinically. We can look up many researchdocuments, which are about the carcinoma, especially in the aspects oflymphomas, melanoma and so on. At the same time, there are someabroad documents' record in the aspect of infection and inflammation,such as juvenile xanthogranuloma. In addition, vitreous cytology is alsoproved to be the valuable auxiliary diagnosis in the aspect of lens andblood-induced glaucoma, and in other aspects.Purpose:Clinically, the above cases are not common.,plus, thetechnology of vitreous cytology also has its own specialties. So it cannotbe used extensively in clinical. This experiment operated the cytopathology examination through the common clinical inflammationchorioretinopathy and try to optimize the present vitreous cytology ways,conclude and establish standard operations from taking out the samples toexamining laboratory, and analyze its application values in the differenttypes' disease.Method: In the period of experiment, according to the preoperativediagnosis, the experimenter makes the hospitalized31inflammationchorioretinopathy' patients divide into3study groups. The first group is21traumatic vitreoretinopathy, including18patients, who arehospitalized to make the suture operation because of eyeball rupture.During the18cases, there are12patients, who are ready to take thesecond vitrectomy because of the vitreous hemorrhage. Another3patientsare hospitalized directly because of the traumatic endophthalmitis. Thesecond group is the center retinal vein occlusion(CRVO), including4patients. The last group has6patients, who are not examined the cause ofdisease because of vitreous opacities. To the eyeball rupture's wounded,the experimenter directly clippings the pure vitreous. To the other patients,the experimenter uses the20-gauge's slicing head to slice and get theundiluted vitreous samples, with the800cpm cutting rates. In addition, tocollect the sterile box's diluted samples. The samples' dealing is throughparaffin embedding to make the paraffin block or through the followingsmear ways,direct smear, smear after the centrifugated resuspension andsmear with the centrifugated deposition's surrounding filtrate. Choose theproper ways of staining, according to the different diseases. All the casesare stained fundamentally with the hematoxylin-eosin staining(HEstaining). To examine pathogen use the acridine orange and Giesma tostain jointly. To the borderline melanin pigment use the Lillieferropophyrin to stain. To some extra samples, the experimenter examinesthe compared effects of using the May-Grunwald Giemsa (MGG) stainingand the HE staining individually. At last, the experimenter records theobserved inflammatory cells' varieties from the different types' diseases, and uses the SPSS statistics to count the vitreous hemorrhage samplesand tests the observed results whether have significance or not.Results:1. The group of traumatic chorioretinopathyThis group's15cases out of the21cases has reached the firstoperation samples,17cases gets the second vitrectomy operation samples,in which just2cases have the first operation samples,4cases have thesecond operation samples,13cases has the first and the second samples.Out of the13cases, there are9cases are full of the brownish blackpigment epithelium,1case obviously has the more polymorph nuclearleukocyte (PMN) and monocyte (Mon),2cases has more PMN, the otherinflammatory cells are less. These3cases take up the traumaticendophthalmitis postoperatively. From these samples, the neutrophil (Neu)and PMN can be seen all over visual field. The Mon, lymphocyte (Lym)and other inflammatory cells also can be seen, but just a little. The PMN,Mon, Lym can be seen rising in6cases, in which traumatic retinaldetachment (TRD) is found in5cases. In samples of the cases that takeup the TRD can be seen a lot of retinal pigment epithelium (RPE) withfull of pigment granule, monocyte (Mon), Lym, Neu.2. The group of center retinal vein occlusion (CRVO)This group has4samples, in which the neuroglia cell can be seenobviously in2patients' samples. The obvious Mon and a little of Neu andLym can be seen in the other samples.3. The group of branch retinal vein occlusion (BRVO) and the group ofretinal vaseulitisThe both groups include6patients, who are hospitalized because ofvitreous hemorrhage, all are mainly the Lym.4. Compared with HE staining and MGG stainingThe both staining can show the structure of cell very well. While thesteps of MGG staining are less, it can test fast. HE staining has moresteps, but its samples can be easily preserved for a long period. 5. The results of different ways to smearCompared with the direct smear to the diluted samples, the smearafter the centrifugated resuspension and the smear with the centrifugateddeposition's surrounding filtrate, the result is the smear after thecentrifugated resuspension is better.Conclusion: During the traumatic patients, vitreous cytology has theauxiliary prompt using to diagnosis and prognosis of the traumaticvitreoretinopathy. Although the application of special staining has notexamined out the pathogen directly, through testing the varieties ofinflammatory cells can indicate the happening of choroid and retina'sdetachment and the endophthalmitis, and supply better methods oftreatment's possibilities for the clinical doctors. In addition, thecytopathology of the other same type's diseases expresses certaincommon characters. These common characters can help us understanddiseases' pathogenesis better and have positive conductive function to theclinical diagnosis and treatment. |
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