title: Ultrastructural changes after artificial retinal detachment with modified retinal adhesion.
abstract: OBJECTIVE
  Artificial retinal detachment is increasingly used in submacular surgery. However, overcoming physiological retinal adhesiveness by subretinal fluid injection is suspected to cause cellular damage and thus to limit visual rehabilitation. This experimental study was designed to examine the ultrastructural changes induced by retinal detachment under vitrectomy conditions and to evaluate factors that reduce adhesiveness and minimize cellular damage.
  
  
  METHODS
  Twenty-one pigmented rabbits underwent vitrectomy, and the vitreous cavity was perfused for 10 minutes with various solutions. These included variations in osmolarity (314 and 500 mOsM), Ca(2+) ion concentration (Ca(2+)-supplemented, low Ca(2+), active Ca(2+) deprivation via 1 mM EDTA), temperature (19 degrees C and 34 degrees C), and ischemia (5 minutes). Nonvitrectomized eyes served as the control. Consecutively, an artificial bleb detachment was created underneath the visual streak by injecting 1 mL of buffered saline solution subretinally. Eyes were enucleated within 3 minutes, fixed with 2% glutaraldehyde/0.1 M cacodylate buffer (pH 7.4) containing 100 mM sucrose and processed for transmission electron microscopy and scanning electron microscopy.
  
  
  RESULTS
  If a Ca(2+)-containing standard solution was used during vitrectomy, retinal adhesiveness was strong, and a forced bleb detachment caused substantial cellular damage characterized by swollen and fragmented photoreceptor outer segments and disruption of retinal pigment epithelial cells. Use of a Ca(2+)-free solution moderately reduced the adhesive strength with consequently less ultrastructural damage. Active Ca(2+)-deprivation further reduced the retinal adhesion, but may have induced damage as suggested by intracellular vacuolization. Hyperosmolarity and ischemic conditions had toxic effects on both the photoreceptors and RPE cells. In contrast, the use of a preheated Ca(2+)-free solution (34 degrees C) substantially reduced retinal adhesiveness under vitrectomy conditions and hence ultrastructural damage.
  
  
  CONCLUSIONS
  Artificial retinal detachment causes substantial ultrastructural damage in eyes with physiological retinal adhesiveness if performed under vitrectomy conditions similar to surgery in humans. The use of a preheated Ca(2+)-free physiologic saline solution seems to be suitable to reduce retinal adhesion sufficiently, without causing significant cellular damage.
authors.affiliation: Department of Ophthalmology 1, Eberhard-Karls University Tübingen, Schleichstrasse 12, 72076 Tübingen, Germany. peter.szurman@med.uni-tuebingen.de
authors.forename: Peter
authors.initials: P
authors.lastname: Szurman
authors.forename: Sigrid
authors.initials: S
authors.lastname: Roters
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.forename: Sabine
authors.initials: S
authors.lastname: Aisenbrey
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schraermeyer
authors.forename: Matthias
authors.initials: M
authors.lastname: Lüke
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Gabriele
authors.initials: G
authors.lastname: Thumann
mesh_terms: D000268:Adhesiveness; D000818:Animals; D002118:Calcium / Q000494:pharmacology; D006358:Hot Temperature; D007511:Ischemia / Q000378:metabolism; D007552:Isotonic Solutions; D008855:Microscopy, Electron, Scanning; D009994:Osmolar Concentration; D010786:Photoreceptor Cells / Q000378:metabolism / Q000648:ultrastructure; D010857:Pigment Epithelium of Eye / Q000378:metabolism / Q000648:ultrastructure; D011817:Rabbits; D012160:Retina / Q000378:metabolism / Q000648:ultrastructure*; D012163:Retinal Detachment / Q000473:pathology*; D014821:Vitrectomy
chemical_list: D007552:Isotonic Solutions; D002118:Calcium