Skip to main content
SpringerLink
Log in

Diabetic choroidal and iris vasculature scanning electron microscopy findings

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Scanning Electron Microscopy (SEM) was used to study vascular casts of twenty-four autopsy eyes taken from patients with long-standing insulin-dependent Diabetes Mellitus. These casts were compared to casts of ten ‘normal’ autopsy eyes from patients without a history of diabetes or other vascular disease. The SEM findings in the choroidal vessels of the diabetic eyes included: increased tortuosity, focal vascular dilations and narrowings, hypercellularity, vascular loops and microaneurysm formation, ‘drop-out’ of choriocapillaries, and sinus-like structure formation between choroidal lobules in the equatorial area. In the iris, neovascularization was evident in the vascular casts in cases with clinically recognized rubeosis iridis. These findings indicate that there is significant involvement of the uveal tract in diabetic eyes. The present study strongly supports the Hidayat and Fine light microscopic observation that the diabetic choroid demonstrates significant vascular changes (e.g. narrowed vessels with possible ‘drop-out’ of capillaries and neovascularization). Changes in the diabetic choroid, especially in the choriocapillaris, may be a contributing factor in diabetic retinopathy, resulting in decreased oxygenation of the outer layer of the retina. Short reviews and updated information of diabetic eye disease provide some additional insights into the vascular problems in the eye.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ashton N. Injection of the retinal vascular system in the enucleated eyes in diabetic retinopathy. Br J Ophthal 1950; 34: 38–41.

    Google Scholar 

  2. Betteridge CJ, El Tahir KEH, Reckless JPD et al. Platelets from diabetic subjects show diminished sensitivity to prostacyclin. Eur J Clin Invest 1982; 12: 395–8.

    Google Scholar 

  3. Bishoff PM, Flower RW. Ten years experience with choroidal angiography using indocyanine green dye: a new routine examination or epilogue? Doc Ophthal 1985; 60: 235–91.

    Google Scholar 

  4. Blankenship GW. A Clinical Comparison of Central and Peripheral Argon Laser Panretinal Photocoagulation for Proliferative Diabetic Retinopathy. Ophthalmology 1988; 95: 170–7.

    Google Scholar 

  5. Bresnick GH, Davis MD, Myers FL, Venecia G. Clinicopathological correlations in diabetic retinopathy. II. Clinical and histological appearance of retinal capillary microaneurysm. Arch Ophthal 1977; 95: 1215–23.

    Google Scholar 

  6. Borrows AW. Beta-thromboglobulin in diabetes: relationship with blood glucose and fibrinopeptide. A Horm Metab Res 1981; 11: 22–5.

    Google Scholar 

  7. Buzney SM, MacDonald SG, Gervino NH. Experimental retinal capillary wall: Interaction of endothelial cells and pericytes in vitro. Invest Ophthal Vis Sci (Supplement) 1984; 25: 159.

    Google Scholar 

  8. Cogan DG, Touissant D, Kuwabara T. Retinal vascular patterns. IV. Diabetic Retinopathy. Arch Ophthal 1961; 66: 366–78.

    Google Scholar 

  9. Cunha-Vaz JA. Pathophysiology of diabetic retinopathy. Br J Ophthal 1978; 62: 351–335.

    Google Scholar 

  10. Ditzel J. Affinity hypoxia as a pathogenetic factor of microangiopathy with particular references to diabetic retinopathy. Acta Endocrinol 1980; 238: 39–55.

    Google Scholar 

  11. L'Esperance FA Jr, James WA. Diabetic retinopathy. Clinical evaluation and management. St. Louis Toronto London: CV Mosby Co, 1981.

    Google Scholar 

  12. Fisher F. Disturbed vascular innervation of the diabetic choroid? International Symposium on the choroid (Procc.) May 11–14. Ittingen 1986; pp. 118–25.

  13. Frank RN. On the pathogenesis of diabetic retinopathy. Ophthalmology 1984; 91: 626–34.

    Google Scholar 

  14. Freyler H, Prskavec F, Stelzer N. Diabetische choroidopatheine retrospective floureszenzangiographische studie. Klin Mbl Augenheilk 1986; 189: 144–7.

    Google Scholar 

  15. Fryczkowski AW, Sato SE. Scanning electron microscopy of the ocular vasculature in diabetic retinopathy. Ophthalmic Forum 1986; 4: 39–50.

    Google Scholar 

  16. Fryczkowski AW. Vascular casting and scanning electron microscopy in diabetes. Scanning Microscopy 1987; 1: 811–6.

    Google Scholar 

  17. Fryczkowski AW, Sherman MD. Angioarchitecture of the human submacular choroid. Acta Anatomica 1988; 132: 165–9.

    Google Scholar 

  18. Heath H, Bridgen WD, Canever JV et al. Platelet adhesiveness and aggregation in relation to diabetic retinopathy. Diabetologica 1971; 7: 308–15.

    Google Scholar 

  19. Hidayat AA, Fine BS. Diabetic choroidopathy. Invest Ophth Vis Sci (suppl) 1983; 24: 247.

    Google Scholar 

  20. Hidayat AA, Fine BS. Diabetic choroidopathy. Light and electron microscopic observations of seven cases. Ophthalmology 1985; 92: 512–22.

    Google Scholar 

  21. Hogan MJ, Alvarado JA, Weddel JE. Histology of the human eye. WB Saunders, Co, Philadelhia, London, Toronto, 1971.

    Google Scholar 

  22. Kinoshita JH. Aldose reductase in the diabetic eye. XLIII Edward Jackson memorial lecture. Am J Ophthal 1986; 102: 685–92.

    Google Scholar 

  23. Kohn RR, Schnider SL. Glucosylation of human collagen. Diabetes 1982; 31: 47–51.

    Google Scholar 

  24. Landrum AC. The hypertension diabetic kidney as a model of so-called collagen disease. Can Med Assoc J 1964; 88: 442–52.

    Google Scholar 

  25. Little HL. Alterations in blood elements in the pathogenesis of diabetic retinopathy. Ophthalmology 1981; 88: 647–54.

    Google Scholar 

  26. Little HL. Pathogenesis. In: L'Esperance FA, James WA, eds. Diabetic retinopathy: Clinical evaluation and management. St. Louis: Mosby, 1981: 74–5.

    Google Scholar 

  27. Little HL. The role of abnormal blood rheology in the pathogenesis of diabetic retinopathy. Am Ophthal Diabetologia 1973; 9: 20–4.

    Google Scholar 

  28. Matusaka T. The role of melanocytes in the choroidal circulation. International symposium on the choroid (Proceed) Ittingen, May 11–14, 1986; pp. 36–9.

  29. Michealson IC. The mode of development of the vascular system of the retina with some observations on its significance for certain retinal diseases. Tr Ophthal Soc UK 1948; 78: 137–80.

    Google Scholar 

  30. Morita I, Takahashi R, Ito H, et al. Increased arachidonic acid content in platelet phospholipids from diabetic patients. Prostaglandins. Leukotrienes Med 1983; 11: 33–41.

    Google Scholar 

  31. Nauman GOH, Uvea. In: Nauman GOH (ed). Pathologie des Auges. Berlin, Springer-Verlag 1980; pp. 408–500.

    Google Scholar 

  32. Onodera H, Hirata T, Sugawara H, et al. Platelet sensitivity to adenosine diphosphate and to prostacyclin in diabetic patients. Tohoku J Exp Med 1982; 137: 423–8.

    Google Scholar 

  33. Paulsen EP, McClung NM, Sabio H. Some characteristics of spontaneous platelet aggregation in young insulin-dependent subjects. Horm Metab Res (Suppl) 1981; 11: 15–21.

    Google Scholar 

  34. Robinson WG Jr, Kador PF and Kinoshita JH. Retinal capillaries. Basement membrane thickening by galactosemia prevented with aldose reductase inhibitor. Science 1983; 211: 1117–21.

    Google Scholar 

  35. Robinson WG Jr, Kador PF, Akagi Y, Kinoshita JH, Gonzalez R, Dvornik D. Prevention of basement membrane thickening in retinal capillaries by a novel inhibitor of aldose reductase, tolrestat. Diabetes 1986; 35: 295–9.

    Google Scholar 

  36. Rosove MH, Frank HJL, Harwig SSL. Plasma betathrom-boglobulin, platelet factor 4, fibrinopeptide 4, and other hemostatic functions during improved short-term glycemic control in diabetes mellitus. Diabetes Care 1984; 7: 174–9.

    Google Scholar 

  37. Saracco JB, Gastand P, Ridings B, Ubawd CA. La choroidopathie diabetique. J Fr Ophthal 1982; 5: 231–6.

    Google Scholar 

  38. Schmid-Schonbein H, Volger E. Red-cell aggregation and red-cell deformability in diabetes. Diabetes 1976; 25: 897–902.

    Google Scholar 

  39. Siperstein MD, Unger RH, Madison LL. Studies of muscle capillary basement membranes in normal subjects, diabetic and prediabetic patients. J Clin Invest 1968; 47: 1973–99.

    Google Scholar 

  40. Stefansson E, Landers MB, III, Wolbarsht ML. Oxygenation and vasodilation in relation to diabetic and other proliferative retinopathies. Ophthalmic Surg 1983; 14: 209–26.

    Google Scholar 

  41. Steinberg RH. Monitoring communications between photoreceptors and pigment. Epithelial cells: Effects of ‘Mild’ systemic hypoxia. Friedenwald lecture. Invest Ophthal Vis Sci 1987; 28: 1888–1904.

    Google Scholar 

  42. Torczynski E, Tso MOM. The architecture of the choriocapillaris at the posterior pole. Am J Ophthal 1976; 81: 428–40.

    Google Scholar 

  43. Van Haeringen NJ, Osterhuis JA, Terpstra J, et al. Erytrocyte aggregation in relation to diabetic retinopathy. Diabetologia 1973; 9: 20–4.

    Google Scholar 

  44. Vracko R, Bendett FP. Restricted replicative life span of diabetic fibroblasts in vitro: Its relation to microangiopathy. Fed Proc 1975; 34: 68.

    Google Scholar 

  45. Wolbarsht ML, Landers MB. The rationale of photocoagulation therapy for proliferative diabetic retinopathy. A review and model. Ophthal Surg 1980; 14: 235–45.

    Google Scholar 

  46. Yanoff M. Ocular pathology of diabetes mellitus. Am J Ophthal 1969; 67: 21–38.

    Google Scholar 

  47. Yasuda H, Harano Y, Kousupi K, et al. Development of early lesions of microangiopathy in chronically diabetic monkeys. Diabetes 1984; 33: 415–20.

    Google Scholar 

  48. Yodaiken RE, Seftel HC, Kew MC, et al. Ultrastructure of capillaries in South African diabetics. II. Muscle capillaries. Diabetes 1969; 18: 164–75.

    Google Scholar 

  49. Yoneya S, Tso MOM, Shimizu K. Patterns of the choriocapillaris. Intnl Ophthal 1983; 6: 95–109.

    Google Scholar 

  50. Yoneya S, Tso MOM. Angioarchitecture of the human choroid. Arch Ophthal 1987; 105: 681–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, The Ohio State University, 456 West Tenth Avenue, 43210, Columbus, OH, USA

    Andrzej W. Fryczkowski & Jonathan Walker

  2. Department of Ophthalomology, The University of Arizona, Tucson, Arizona, USA

    Barton L. Hodes

Authors
  1. Andrzej W. Fryczkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barton L. Hodes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fryczkowski, A.W., Hodes, B.L. & Walker, J. Diabetic choroidal and iris vasculature scanning electron microscopy findings. Int Ophthalmol 13, 269–279 (1989). https://doi.org/10.1007/BF02280087

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02280087

Key words

Search

Navigation