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Retinal Pathology Dick Dubielzig
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Retinal Pathology - In Focus Retinal Diseases • Canine distemper ... – Clusters of GFAP+ cells in the vitreous behind ... Retinal Pathology

Mar 18, 2018

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Page 1: Retinal Pathology - In Focus Retinal Diseases • Canine distemper ... – Clusters of GFAP+ cells in the vitreous behind ... Retinal Pathology

Retinal Pathology

Dick Dubielzig

Page 2: Retinal Pathology - In Focus Retinal Diseases • Canine distemper ... – Clusters of GFAP+ cells in the vitreous behind ... Retinal Pathology

Normal Retina

Page 3: Retinal Pathology - In Focus Retinal Diseases • Canine distemper ... – Clusters of GFAP+ cells in the vitreous behind ... Retinal Pathology

Normal Primate Fovea

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Golden Eagle Convexiclivate Fovea

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Multi-focal ERG

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AvianPhotoreceptors

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Cystoid Change in Dogs and Cats

• Dogs– Cystic degeneration in the retinal neuropil– Cystic spaces have hyaluronic acid– Age related

• Cats– Cystic changes are in the pars plana epithelium– Cystic spaces filled with hyaluronic acid– Age related

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Feline

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Canine

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Retinal Folds/Dysplasia

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Vitreoretinal dysplasia

• General characteristics– Retinal detachment and giant tear in severe

cases– Liquid vitreous or vitreous strands– Disorganized retina, rarely

• Oculoskeletal syndrome• Shih Tzu vitreoretinopathy• Feline vasoproliferative vitreoretinopathy

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Oculoskeletal DysplasiaLabrador/Samoyed

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Oculoskeletal syndrome

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Oculoskeletal syndrome

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Growth plate

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Oculoskeletal syndrome

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Oculoskeletal syndrome

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Oculoskeletal syndrome: Inner retinal gliosis

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Shih Tzu Vitreoretinopathy

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Shih Tzu Vitreoretinopathy

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Feline vasoproliferativevitreoretinopathy

• Seen as a developmental disorder in young cats• Avascular peripheral retina and vascularized

vitreous in the area of the central retina• Interrupted vascularizaton of the peripheral retina

like Retinopathy of Prematurity (ROP)• Features other than the primary lesions

– Retinal detachment– PIFM and PAS– Glaucoma– Hemorrhage

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80% OXYGEN FOR 21 DAYS AND THEN ROOM AIRExperimental Retinopathy of Prematurity (ROP)

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Feline Vasoproliferative Vitreoretinopathy

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Feline Vasoproliferative Vitreoretinopathy

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GFAP

Lamanin

Retina H&E

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Feline Vasoproliferative VitreoretinopathyAvascular Peripheral Retina

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PIFM - Preiridal fibrovascular membrane

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Photoreceptor Loss• Progressive Retinal Atrophy (PRA)• Phototoxic Retinopathy• FluoroquinoloneToxicity in Cats• Taurine Deficiency in Cats• Oxidative Stress &/or Vit E Selenium Def.• SARDS• Phototoxicity• Other Toxic Reactions

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PRA

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Normal Irish Setter Early PRA Irish Setter

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Phototoxic RetinopathyAlbino Laboratory Rodents

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Fluoroquinolone retinal toxicity in cats

• Baytril™ (Enrofloxacin)– Discovered after Bayer was allowed to switch

from 2.5 mg/kg to 5 to 20 mg/kg– Disappeared after the dose was dropped to no

more than 5 mg/kg

• Orbifloxacin™ (Orbax))– Discovered in a safety evaluation after

the Baytril issue became public

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Fluoroquinolone retinal toxicity

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Acute Baytril™ Toxicity

Control

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Three Day Toxicity

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Five Day Toxicity

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Seven Day Toxicity

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Control

50 mg/kg

Thirty Day ChronicRetinopathy, Orbax ™

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Control

50mg/kg

Thirty Day ChronicRetinopathy, Orbax™

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50mg/kg

Control

Baytril™

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Feline Central Progressive Retinal Degeneration (Taurine Deficiency)

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Feline Central Progressive Retinal Degeneration

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Feline Central Progressive Retinal Degeneration

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Feline Central Progressive Retinal Degeneration

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Feline Central Progressive Retinal Degeneration

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Feline Central Progressive Retinal Degeneration

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Canine Central Progressive Retinal Atrophy

Retinal Lipofuscinosis

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Central Progressive Retinal Atrophy

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PAS stain

Autofluorescence

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Retinal toxicity

RPE cell swelling

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Canine Hemeralopia

Definition (Millodot’s Dictionary of Optometry and Visual Science)– A term used to mean either night blindness …

or Day blindness…– European definition … night blindness

• Day Blindness in Alaskan Malamute• Achromatopsia

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Phototoxicity in Albino Rodents

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Acute Phototoxicity in Albino Mice

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Retinal Trauma/Contusion• A blunt blow to the eye at just the right

force sets up an energy wave which propagates through the retina and fragments the tissue.

• A more powerful force will tear the retina, but not propagate as a wave.

• A less powerful force can cause reversible damage with no detectable structural damage.

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Acute Severe Trauma

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Dog

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Lenticular metaplasia in the traumatized bird retina

• Lenticular metaplasia can be induced in vitro in the chick embryo, but not the hatched bird retina (Research that was popular until the mid-80s)

• Müller cells switch from GFAP to αA-crystallin

• Cells become phenotypical lens balloon cells

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Owl Congenital

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Owl..CongenitalLenticular metaplasia

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Duck

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Eagle..Trauma

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αA-crystallin

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Lenticularmetaplasia

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Sudden Acquired Retinal Degeneration Syndrome

(SARDS)• Sudden blindness• Flat ERG, indicative of photoreceptor

damage• Affected dogs have

– PU/PD– Obese– Polyphagia

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SARDS

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SARDS

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SARDS

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Apoptosis by TUNEL assay

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Retinal Detachment• Normal retina prevented from detaching because

of the tight junctions of the Müller cells and tight junctions at the apex of the RPE cells

• Vitreous body provides gentle support• Morphologic features

– Material in subretinal space– Hypertrophy of RPE cells

• Risk Factors for Detachment– Trauma– Vascular leakage– Retinal traction– Retinal holes

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Normal Retina

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Subretinalfluid

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Giant Retinal Tear(Equine)

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RPE hypertrophy, “tombstoning”

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Not likely to be Retinal Detachment

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Retinal holes

• Causes of retinal holes– Trauma– Traction– Retinal degeneration– Infarction

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Retinal holes

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Giant RetinalTear

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RetinalHoles

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Viral Retinal Diseases

• Canine distemper• Herpes in llama• West Nile virus in raptors

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Canine Distemper

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Canine Distemper

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Canine Distemper

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Canine Distemper

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Herpesvirus Retinitis in Llamas

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Herpesvirus Retinitis in Llamas

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Herpesvirus retinitis:

Retinal degeneration &

Viral inclusion bodies

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Herpesvirus Retinitis in Llamas

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West Nile Virus in Raptors

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West Nile Virus in Raptors

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West Nile Virus in Raptors

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West Nile Virus in Raptors

Pectenitis

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West Nile Virus in Raptors

Immunohistochemistry

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Equine Senile Retinal Degeneration

• Seldom clinically significant• Multi-focal to coalescing peripheral retinal

degeneration• Abnormal RPE neuroretinal relationship

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With retina

Retina removed, showing RPEchanges

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PAS+ membranousmatrix material

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Ora ciliaris retinae

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RPE Hypertrophy

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Bilateral Optic Atrophy of Macaques• Variable decrease in ganglion cells in the macula

with NO OTHER changes in the retina• Decreased axons in the temporal aspect of the

optic nerve and NO OTHER changes• No behavioral changes noted • Severe changes can be picked up on fundoscopy

but the mild changes are difficult to recognize• Not detected on standard ERG• Severe changes associated with diminished flash

VEP• Southeast Asian origin???

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Bilateral Optic Atrophy of MacaquesNormal Male

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Bilateral Optic Atrophy of MacaquesNormal MaleTemporal

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Bilateral Optic Atrophy of MacaquesNormal Male

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Bilateral Optic Atrophy of MacaquesSeverely-affected Female

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Bilateral Optic Atrophy of MacaquesSeverely-affected Female

Temporal Nasal

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Bilateral Optic Atrophy of MacaquesSeverely-affected Female

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Bilateral Optic Atrophy of MacaquesModerately-affected Male

Temporal Nasal

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Bilateral Optic Atrophy of Macaques Moderately-affected Male

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Moderately-affected Control Female

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Moderately-affected Control Female

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Moderately-affected Control Female

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Hypertensive Choroidal and Retinal Vasculopathy

• Affects both dogs and cats• Vascular disease can be localized and needs

to be searched for with a PAS stain• Hemorrhage, retinal detachment• Rarely affects the iris

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Hypertensive Vasculopathy

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Hypertensive Vasculopathy

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Hypertension

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Hypertensive Vasculopathy

FibrinoproliferativeLesion

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Hypertensivevasculopathyin the choroid

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Diabetic Retinopathy in DogsAlthough clinical complications of

spontaneous diabetic retinopathy in dogs are extremely rare, the dog has successfully been used experimentally to induce diabetic retinopathy.

Proliferative neovascularizationand retinal detachment are the only features which cannot be induced.

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Canine Experimental Diabetic Retinopathy

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Canine Experimental Diabetic Retinopathy

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Canine Trypsin Digest

Normal Diabetic

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Canine ocular gliovascular syndrome

• The syndrome consists of the following:– Intraocular hemorrhage– Neovascular glaucoma– Retinal detachment– Clusters of GFAP+ cells in the vitreous behind

the lens– Neovascular proliferation extending into the

vitreous from the retina or optic nerve head• Glassy hyalin collagen surrounds the

neovascular proliferation

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Canine ocular gliovascular syndrome

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Glial Cells

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GFAPGFAP

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Retinal Tumors in dogs22 cases in COPLOW/5964 total tumors

• Glioma (astrocytoma)– GFAP+– Usually central +/-

extension into the optic nerve

– Optic nerve extension determines prognosis

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Other retinal tumors

GFAP

Synaptophysin

Page 140: Retinal Pathology - In Focus Retinal Diseases • Canine distemper ... – Clusters of GFAP+ cells in the vitreous behind ... Retinal Pathology

Retinoblastoma, human