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The Role of Lipid Thrombi in the Pathogenesis of Diabetic Retinopathy

The Role of Lipid Thrombi in the Pathogenesis of Diabetic Retinopathy Abstract DESPITE the prominence of the vascular changes in diabetic retinopathy, the nature of the angiopathy is not fully understood. In particular, the concepts that retinal arterioles and capillaries are occluded by lipid thrombi and that the capillary thrombi are of importance in the genesis of microaneurysms, have not been appreciated. The purpose of this article is to focus attention on these unique pathological changes and to document their relationship to microaneurysmal formation and to certain other retinal lesions of diabetic retinopathy. Materials and Methods The clinical records of 13 patients with diabetes mellitus, in whom the eyes had been removed postmortem, were reviewed. The clincial data in each case included the results of a history and physical examination by at least two physicians. In most instances there were multiple admissions to the hospital and visits to the outpatient clinics so that sequential retinal changes were carefully recorded. Consultations with the References 1. Kuwabara, T., and Cogan, D.G.: Studies of Retinal Vascular Patterns: I. Normal Architecture , Arch Ophthal 64:904-911, 1960.Crossref 2. Ashton, N.: Vascular Changes in Diabetes With Particular Reference to the Retinal Vessels , Brit J Ophthal 33:407-420, 1949.Crossref 3. Bloodworth, J.M.B., Jr.: Diabetic Microangiopathy , Diabetes 12:99-114, 1963. 4. Bloodworth, J.M.B., Jr.: Diabetic Retinopathy , Diabetes 11:1-22, 1962. 5. Banson, B.B., and Lacy, P.E.: Diabetic Microangiopathy in Human Toes , Amer J Path 45:41-58, 1964. 6. Kohner, E.M., et al: Arterial Fluorescein Studies in Diabetic Retinopathy , Diabetes 16:1-10, 1967. 7. Ashton, N.: Arteriolar Involvement in Diabetic Retinopathy , Brit J Ophthal 37:282-292, 1953.Crossref 8. Ashton, N.: Studies of the Retinal Capillaries in Relation to Diabetic and Other Retinopathies , Brit J Ophthal 47:521-538, 1963.Crossref 9. Wilens, S.L.; Elster, S.K.; and Baker, J.P.: Glomerular Lipoidosis in Intercapillary Glomerulosclerosis , Ann Intern Med 34:592-607, 1951.Crossref 10. Hartcroft, W.S.: Fat Emboli in Glomerular Capillaries of Choline-Deficient Rats and of Patients With Diabetic Glomerulosclerosis , Amer J Path 31:381-397, 1955. 11. Ballantyne, A.J., and Loewenstein, A.: The Pathology of Diabetic Retinopathy , Trans Ophthal Soc UK 63:95-115, 1944. 12. Pope, C.H.: Retinal Capillary Microaneurysms , Diabetes 9:9-13, 1960. 13. Raphael, S.S., and Lynch, M.J.G.: Kimmelstiel-Wilson Glomerulonephropathy , Arch Path 65:420-431, 1958. 14. Cogan, D.G., and Kuwabara, T.: Capillary Shunts in the Pathogenesis of Diabetic Retinopathy , Diabetes 12:293-300, 1963. 15. Ashton, N., and Henkind, P.: Experimental Occlusion of Retinal Arterioles (Using Graded Glass Ballotini) , Brit J Ophthal 49:225-234, 1965.Crossref 16. Dollery, C.T., et al: Retinal Microemboli: Experimental Production of "Cotton-Wool" Spots , Lancet 1:1303-1305, 1965. 17. Dollery, C.T., et al: Focal Retinal Ischaemic, Ophthalmoscopic, Circulatory and Ultrastructural Changes , Brit J Ophthal 50:285-324, 1966.Crossref 18. Cook, C.A.G.: Role of Fat Emboli in Diabetic Retinopathy , Brit J Ophthal 41:741-745, 1957.Crossref 19. Ashton, N.: Hypertensive Retinopathy , Lancet 1:866-867, 1963. 20. Klien, B.A.: Sidelights on Retinal Venous Occlusion , Amer J Ophthal 61:25-35, 1966. 21. Ashton, N.: Ocular Changes in Multiple Myelomatosis , Arch Ophthal 73:487-494, 1965.Crossref 22. Ashton, N.; Kok, D'A.; and Foulds, W.S.: Ocular Pathology in Macroglobulinaemia , J Path Bact 86:453-461, 1963.Crossref 23. Goodman, G.; von Sallman, L.; and Holland, M.G.: Ocular Manifestations of Sickle Cell Disease , Arch Ophthal 58:655-682, 1957.Crossref 24. Walters, J.H.: Vascular Occlusion in Sickle Cell Disease , Proc Roy Soc Med 51:646-648, 1958. 25. Wolter, J.R., and Liss, L.: The Evolution of Hyaline Corpuscles (Cytoid Bodies) in the Human Optic Nerve , Arch Ophthal 43:855-892, 1957. 26. Klien, B.A.: Comments on the Cotton-Wool Lesion of the Retina , Amer J Ophth 59:17-23, 1965. 27. Gofman, J.W., et al: Blood Lipids and Human Atherosclerosis , Circulation 2:161-178, 1950.Crossref 28. New, M.I.: et al: The Significance of Blood Lipid Alterations in Diabetes Mellitus , Diabetes 12:208-212, 1963. 29. Schrade, W., et al: Fatty Acid Composition of Lipid Fractions in Diabetic Serum , Lancet 1:285-290, 1963.Crossref 30. Introzzi, P.; Bernascoric, C.; and Buscarini, L.: Serum Proteins, Lipids, and Protein-Bound Carbohydrates in Vascular Complications of Diabetes Mellitus , Acta Med Scand 160:47-58, 1958.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Role of Lipid Thrombi in the Pathogenesis of Diabetic Retinopathy

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Publisher
American Medical Association
Copyright
Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1967.04410010011002
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Abstract

Abstract DESPITE the prominence of the vascular changes in diabetic retinopathy, the nature of the angiopathy is not fully understood. In particular, the concepts that retinal arterioles and capillaries are occluded by lipid thrombi and that the capillary thrombi are of importance in the genesis of microaneurysms, have not been appreciated. The purpose of this article is to focus attention on these unique pathological changes and to document their relationship to microaneurysmal formation and to certain other retinal lesions of diabetic retinopathy. Materials and Methods The clinical records of 13 patients with diabetes mellitus, in whom the eyes had been removed postmortem, were reviewed. The clincial data in each case included the results of a history and physical examination by at least two physicians. In most instances there were multiple admissions to the hospital and visits to the outpatient clinics so that sequential retinal changes were carefully recorded. Consultations with the References 1. Kuwabara, T., and Cogan, D.G.: Studies of Retinal Vascular Patterns: I. Normal Architecture , Arch Ophthal 64:904-911, 1960.Crossref 2. Ashton, N.: Vascular Changes in Diabetes With Particular Reference to the Retinal Vessels , Brit J Ophthal 33:407-420, 1949.Crossref 3. Bloodworth, J.M.B., Jr.: Diabetic Microangiopathy , Diabetes 12:99-114, 1963. 4. Bloodworth, J.M.B., Jr.: Diabetic Retinopathy , Diabetes 11:1-22, 1962. 5. Banson, B.B., and Lacy, P.E.: Diabetic Microangiopathy in Human Toes , Amer J Path 45:41-58, 1964. 6. Kohner, E.M., et al: Arterial Fluorescein Studies in Diabetic Retinopathy , Diabetes 16:1-10, 1967. 7. Ashton, N.: Arteriolar Involvement in Diabetic Retinopathy , Brit J Ophthal 37:282-292, 1953.Crossref 8. Ashton, N.: Studies of the Retinal Capillaries in Relation to Diabetic and Other Retinopathies , Brit J Ophthal 47:521-538, 1963.Crossref 9. Wilens, S.L.; Elster, S.K.; and Baker, J.P.: Glomerular Lipoidosis in Intercapillary Glomerulosclerosis , Ann Intern Med 34:592-607, 1951.Crossref 10. Hartcroft, W.S.: Fat Emboli in Glomerular Capillaries of Choline-Deficient Rats and of Patients With Diabetic Glomerulosclerosis , Amer J Path 31:381-397, 1955. 11. Ballantyne, A.J., and Loewenstein, A.: The Pathology of Diabetic Retinopathy , Trans Ophthal Soc UK 63:95-115, 1944. 12. Pope, C.H.: Retinal Capillary Microaneurysms , Diabetes 9:9-13, 1960. 13. Raphael, S.S., and Lynch, M.J.G.: Kimmelstiel-Wilson Glomerulonephropathy , Arch Path 65:420-431, 1958. 14. Cogan, D.G., and Kuwabara, T.: Capillary Shunts in the Pathogenesis of Diabetic Retinopathy , Diabetes 12:293-300, 1963. 15. Ashton, N., and Henkind, P.: Experimental Occlusion of Retinal Arterioles (Using Graded Glass Ballotini) , Brit J Ophthal 49:225-234, 1965.Crossref 16. Dollery, C.T., et al: Retinal Microemboli: Experimental Production of "Cotton-Wool" Spots , Lancet 1:1303-1305, 1965. 17. Dollery, C.T., et al: Focal Retinal Ischaemic, Ophthalmoscopic, Circulatory and Ultrastructural Changes , Brit J Ophthal 50:285-324, 1966.Crossref 18. Cook, C.A.G.: Role of Fat Emboli in Diabetic Retinopathy , Brit J Ophthal 41:741-745, 1957.Crossref 19. Ashton, N.: Hypertensive Retinopathy , Lancet 1:866-867, 1963. 20. Klien, B.A.: Sidelights on Retinal Venous Occlusion , Amer J Ophthal 61:25-35, 1966. 21. Ashton, N.: Ocular Changes in Multiple Myelomatosis , Arch Ophthal 73:487-494, 1965.Crossref 22. Ashton, N.; Kok, D'A.; and Foulds, W.S.: Ocular Pathology in Macroglobulinaemia , J Path Bact 86:453-461, 1963.Crossref 23. Goodman, G.; von Sallman, L.; and Holland, M.G.: Ocular Manifestations of Sickle Cell Disease , Arch Ophthal 58:655-682, 1957.Crossref 24. Walters, J.H.: Vascular Occlusion in Sickle Cell Disease , Proc Roy Soc Med 51:646-648, 1958. 25. Wolter, J.R., and Liss, L.: The Evolution of Hyaline Corpuscles (Cytoid Bodies) in the Human Optic Nerve , Arch Ophthal 43:855-892, 1957. 26. Klien, B.A.: Comments on the Cotton-Wool Lesion of the Retina , Amer J Ophth 59:17-23, 1965. 27. Gofman, J.W., et al: Blood Lipids and Human Atherosclerosis , Circulation 2:161-178, 1950.Crossref 28. New, M.I.: et al: The Significance of Blood Lipid Alterations in Diabetes Mellitus , Diabetes 12:208-212, 1963. 29. Schrade, W., et al: Fatty Acid Composition of Lipid Fractions in Diabetic Serum , Lancet 1:285-290, 1963.Crossref 30. Introzzi, P.; Bernascoric, C.; and Buscarini, L.: Serum Proteins, Lipids, and Protein-Bound Carbohydrates in Vascular Complications of Diabetes Mellitus , Acta Med Scand 160:47-58, 1958.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1967

References