Eviscerations

Why eviscerate? Scleral shell left behind –better cosmesis. Indications: blind painful..painless / disfigured / not responding to treatment eye scenarios. Comprise of blood frags, corneo-scleral disc, retina and uveal tissue, lens (lens prosthesis), vitreous.

What do you do with them? Examine all fragments. Bisect tissues H&E, PAS, Perls +/- bug stains. Are there histological hallmarks of sympathetic ophthalmia. Any tumour? Any pathology that can inform how the other eye will do?

Band keratopathy Dystrophic calcification

Acute inflammation

Chronic inflammation-chronic keratitis Blood vessels Plasma cells

Infective agent-bacteria

Endothelial Cell Loss

Host-donor interface scar

New vessels on anterior stromal surface

Ectropion uveae, secondary to rubeosis

Fig 8.23 Rubeotic glaucoma

Grossly thickened basement membrane of pars plicata

Brown pigment clogging trabecular meshwork

Proliferative diabetic retinopathy Note new-vessels, surrounded Fibrous tissue on retinal surface.

Normal retinal arteriole

Arteriolosclerosis-note thick wall-called hyalinisation. Hyalinisation due to accumulation of lipid and fibrin, from leaky vessel, due to pericyte death

Occluded branch venule. Note inflammation around vessel -attempts at organisation of thrombus

Perl’s stain picks up haemosiderin Stains it intense blue. This indicates previous intra-retinal haemorrhage from BRVO

Hard druse. Pink, homogeneous nodular material Lies between RPE basement membrane and inner collagenous part of Bruch’s. Note overlying RPE arophy

Fluffier, more diffuse, soft drusen Thickened Bruch’s Fluffier, more diffuse, soft drusen

Thick Bruch’s, hard drusen and complete loss of photoreceptors

CNVM RPE RPE RETINA Haemorrhage of CNVM. CNVM lies between neural retina And RPE Eventual organisation of haemorrhage Will lead to disciform scar. RPE choroid CNVM RPE RETINA

Vessel of CNVM CNVM choroid RPE

Choriocapillaris intact Granulomatous (non-caseating) inflammation of uvea (choroid in this case), sparing the choriocapillaries

PRP SCAR

Loss of choriocapillaris Loss of RPE Bruch’s Gliotic retina PRP SCAR-loss of RPE and choriocapillaris Retinochoroidal atrophy Retinal gliosis Gliotic retina in direct apposition to Bruch’s