Objective To observe the clinical features of polypoidal choroidal vasculopathy (PCV) with retinal pigment epithelium (RPE) tears. Methods Twelve patients of PCV with RPE tears (12 eyes) were enrolled in this study. The patients included eight males and four females, with a mean age of 58.6 years (from 39 to 71 years old). All the patients were affected unilaterally, including eight right eyes and four left eyes. There were one eye with serous RPE detachment and 11 eyes with hemorhagic RPE detachment. All the patients were examined for fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA), three patients were examined for optical coherence tomography (OCT). The location of RPE tear was classified as within vascular arcade, on vascular arcade, and outside vascular arcade. The shape of tear was classified as crescent, semilunar, or irregular. The features of fundus, FFA, ICGA and OCT were observed. Results Fundus examination presents a gray lesion in all eyes. The location of tear were within vascular arcade in four eyes (33.3%), on vascular arcade in five eyes (41.7%) and outside vascular arcade in three eyes (25.0%). The shape of tears were crescent (one eye, 8.3%), semilunar (ten eyes, 83.3%) or irregular (one eye, 8.3%). The RPE tear region present transimitted fluorescence of at the early stage of FFA and hyperfluorescence with a clear border at late stage. There was no leakage, and at the border of hyperfluorescence, blockage fluorescence of rolled and contracted RPE was present. In ICGA manifestation, transimitted fluorescence was found in RPE tear region at early stage, and a clear border was seen in nine eyes at late stage. There was also blockage fluorescence in ICGA of contracted RPE. In OCT manifestation, the RPE reflections were disappeared, and at the margin of tear, the contracted RPE present a dense rolled b reflection. Conclusions In PCV patients, RPE tears are semilunar and usually located within or around the vascular arcade. Fundus angiography shows transimitted fluorescence at the RPE tear region, and curl blockage fluorescence at the edges. OCT shows RPE reflection is disappeared in the tear region and a b reflection at the edges.
Objective To evaluate the toxic effects of staphylococcus aureus exotoxins and neutrophils on retinal pigment epithelium (RPE) cells (RPEC). Methods An in-vitro model of bacteroidal endophthalmitis was established by co-culturing of human RPE cell line D407 and human peripheral blood neutrophils in the present of staphylococcus aureus exotoxins ATCC29213. The level of lactate dehydrogenase hydroxide（LDH）in the cuture supernant was measured, and the viability of RPE was evlauated by flow cytometry and Hoechst 33342/Propidium Iodide（PI）staining. Results When RPE cells were cultured with the exotoxin ATCC29213, the LDH level and necrotic RPE cells were positive proportional to the dosage of exotoxin, but only 250mu;l or 500mu;l of ATCC29213 had a statistical significant effect. When RPE cells were co-cultured with neutrophils in the present of ATCC29213 for 6 hours, 100mu;l of ATCC29213 already had a statistical significant effect on LDH level and necrotic RPEC, and the effect was proportional to the amount of neutrophils in the culture. Conclusion Both staphylococcus aureus exotoxins and neutrophils can damage the RPEC by inducing necrosis, and their function had synergetic effect.