ophthalmic pathology emiko furusato, m.d. department of neuropathology and ophthalmic pathology...
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Ophthalmic Pathology
Emiko Furusato, M.D.
Department of Neuropathology and Ophthalmic PathologyArmed Forces Institute of Pathology
A joint conference with MAPA and PANE 2009
Contents
• Grossing the globe• Ocular histology• 10 Representative cases
Grossing the ocular specimen
• Four basic steps
1. Orient the specimen and determine laterality2. Measurements3. Transillumination (TI)4. Sectioning the globe
Grossing the ocular specimen
• Anatomic landmarks that orient the specimen– Cornea: Horizontal meridian is wider– Long posterior ciliary vessels: Blue line marks
horizontal meridian posteriorly– Inferior oblique: Inferotemporal quadrant, nasal
end near fovea, no tendon– Superior oblique: Superiorly and temporally, shiny
tendinous insertion
1. Orient the specimen and determine laterality
Posterior aspect of left eye
Temporal side Nasal side
Long ciliary vessel
Optic nerve
Vortex vein
Inferior oblique muscle
Superior oblique muscle
Posterior aspect of right eye
Temporal sideNasal sideNasal side
Inferior oblique muscle
Superior oblique muscleOptic nerve
Long ciliary vessels
Anterior aspect of right eye
Nasal sideTemporal side
Horizontal diameter :11 mm
Vertical diameter: 10mm
Grossing the ocular specimen
• Globe: – AP (antero-posterior including the cornea),
Horizontal, Vertical, length of the optic nerve – Normal eye (24 mm = one inch) in diameter
• Cornea: Horizontal and vertical planes – 12 (horizontal) x11mm (vertical) or 11X10mm.
• Diameter of pupil• Note dimensions of any lesions such as wounds,
tumors, etc
2. Measurements
Grossing the ocular specimen 3.Transillumination (TI)
Grossing the ocular specimen
• Transilluminated prior to dissection. • Use dissecting microscope illuminator in a darkened
room.• Applications
– Uveal malignant melanoma – Dark shadow on the sclera
3.Transillumination (TI)
Pupil
Dark band of ciliary body
Pigmented tumor show round shadow
Ciliochroidal melanoma
Retinal detachment
Lens
Ciliary body
Optic nerve
Grossing the ocular specimen
Initial cut: Cornea side down
Superior calotte
Optic nerve
4.Sectioning for the globe
Pupillary Optic nerve (PO) section
Inferior calotte
Second cut: Cut surface down
Grossing the ocular specimen
4.Sectioning the globe
Inferior calotte
Grossing the ocular specimen
4.Sectioning the globe
Retinal detachment
Posterior synechiae
Cornea
Lens
Choroid Subretinal exudate
Ocular Histology
• Conjunctiva• Cornea • Iris / Ciliary body• Lens• Retina• Choroid
Ocular Histology
•Conjunctiva‒ Epithelium, goblet cells‒ Stroma
•Topographic zones‒ Tarsal (palpebral)‒ Fornix ‒ Bulbar
Histology: Conjunctiva
Ocular Histology
Histology: Cornea
• Epithelium– Nonkeratinizing, 5-layered
• Bowman’s layer– Thick collagenous layer underlying the
basal cell basement membrane• Stroma
– Collagen lamellae secreted by fibroblasts interrupted by large artifactual clefts
• Descemet’s membrane• Endothelium
– Single layer of cuboidal cells
Ocular Histology
Histology: Iris & Ciliary body
• Iris (anterior to posterior 4 zone)– Anterior border layer– Stroma– Partially pigmented epithelium– Completely pigmented posterior pigment epithelium Sphinctor muscle appears as a ring in the pupillary stroma
• Ciliary body- Nonpigmented ciliary epithelium- Pigmented ciliary epithelium- Stroma, ciliary muscle
Histology : Iris/ ciliary body• Iris
– Anterior limiting layer’-Stroma• Sphincter pupillae•Pigment epithelium( double layer)
•Ciliary body•Nonpigmented epithelium-Pigmented epithelium’-Stroma, ciliary muscle
Ocular Histology
Histology : Lens•Lens capsule
•Anterior: single-layer, cuboidal, inverted lens epithelium secretes the overlying thick basemembrane •Posterior: No epithelium therefore, remains thinner than anterior capsule
• Lens cortex and nucleus•Layers of lens cells (‘fibers’) that become compressed as they move inward
Ocular Histology
Histology : Retina
Internal limiting membrane
Nerve fiber layer
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
External limiting membrane
Photoreceptors, Rods and cones
Retinal pigment epithelium
Histology : Choroid/Sclera•Choroid
–Bruch’s membrane–Choriocapillaris–Chroidal stroma–Suprachroidal (potential) space
•Sclera –Stroma–Episclera
Physiologically thin ( limbus, behind the insertion of the rectus muscles and around Optic nerve)
10 Representative cases
Conjunctival Cases
Case 1
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