title: Proliferative diabetic retinopathy with lymphocyte-rich epiretinal membrane associated with poor visual prognosis.
abstract: OBJECTIVE
  The aim of this study was to analyze lymphocyte infiltration using immunohistochemistry in proliferative diabetic retinopathy (PDR) membranes.
  
  
  METHODS
  Sixteen patients, 13 with PDR and 3 without diabetes, underwent pars plana vitrectomy, and the epiretinal membrane was peeled. Formalin-fixed, paraffin-embedded epiretinal membrane tissues were processed for immunohistochemistry with anti-leukocyte common antigen (LCA), CD3, and CD20 antibodies. Lymphocyte density was determined by direct counting at a high magnification under a light microscope, which was compared with the patients' visual prognoses.
  
  
  RESULTS
  The lymphocyte density ranged from 1 to 52 (mean, 9.5) in high-power fields. Of 13 membranes, 5 showed a lymphocyte density of >5 cells, whereas the other 8 membranes showed a cell number of <2. The former type is defined as a lymphocyte-rich epiretinal membrane (LERM). Infiltrated lymphocytes were immunohistochemically positive for CD3, a T-cell marker, but not for CD20, a B-cell marker. All patients with LERM had poor visual prognosis after vitrectomy. In contrast, the visual prognosis in 7 patients with non-LERM improved or remained unchanged. A significant association was observed between high-level lymphocyte infiltration in the epiretinal membrane and poor visual prognosis (P < 0.001). LCA(+) mononuclear cells were not observed in epiretinal membranes in the absence of diabetes.
  
  
  CONCLUSIONS
  These results suggest that the high-level infiltration of T lymphocytes into the PDR membrane is well correlated with poor visual prognosis. Histopathologic observation of the epiretinal membrane in patients with PDR may provide significant prognostic information.
authors.affiliation: Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kaseron@med.hokudai.ac.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Kase
authors.forename: Wataru
authors.initials: W
authors.lastname: Saito
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Ohno
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishida
mesh_terms: D000328:Adult; D000368:Aged; D018951:Antigens, CD20 / Q000378:metabolism; D017252:CD3 Complex / Q000378:metabolism; D002465:Cell Movement / Q000502:physiology*; D003930:Diabetic Retinopathy / Q000276:immunology* / Q000601:surgery; D019773:Epiretinal Membrane / Q000276:immunology* / Q000601:surgery; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D017493:Leukocyte Common Antigens / Q000378:metabolism; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013601:T-Lymphocytes / Q000276:immunology*; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy
chemical_list: D018951:Antigens, CD20; D017252:CD3 Complex; D017493:Leukocyte Common Antigens