Histopathology and regression of retinal hard exudates in diabetic retinopathy after reduction of elevated serum lipid levels.
OBJECTIVE
To describe a regression of retinal hard exudates in 2 patients with diabetic maculopathy, and to report immunohistologic findings reflecting lipid deposition in the retina.


METHODS
Two interventional case reports.


METHODS
Two patients with exudative diabetic maculopathy were treated to normalize serum lipids. Histologic examination and immunohistochemistry of each patient's eyes were performed to assess the localization of apolipoprotein B and cholesteryl ester, both of which are principal components of low-density lipoprotein.


RESULTS
Both patients showed a dramatic regression of retinal hard exudates after correction of dyslipidemia. Histopathology revealed diffuse lipids and cholesteryl ester in the retina. Apolipoprotein B and macrophages were colocalized in the perivascular space.


CONCLUSIONS
The regression of hard exudates was most likely due to the aggressive lipid lowering in both patients. The novel histopathologic findings of hard exudate and diabetic maculopathy are similar to the pathologic changes observed in larger atherosclerotic lesions, except that they occur in the intraretinal perivascular space.
Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Michael
M
Cusick
Emily Y
EY
Chew
Chi-Chao
CC
Chan
Howard S
HS
Kruth
Robert P
RP
Murphy
Frederick L
FL
Ferris
D000328:Adult; D001055:Apolipoproteins B / Q000378:metabolism; D002788:Cholesterol Esters / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000473:pathology / Q000628:therapy; D003930:Diabetic Retinopathy / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D004035:Diet Therapy; D005081:Exercise Therapy; D005122:Exudates and Transudates; D017809:Fatal Outcome; D005451:Fluorescein Angiography; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006949:Hyperlipidemias / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007124:Immunoenzyme Techniques; D017075:Laser Coagulation; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012171:Retinal Vessels / Q000378:metabolism / Q000473:pathology*; D019821:Simvastatin / Q000627:therapeutic use*
D001055:Apolipoproteins B; D002788:Cholesterol Esters; D006442:Glycated Hemoglobin; D000960:Hypolipidemic Agents; D008055:Lipids; D019821:Simvastatin