BY
Tore KorneruiiRetinopathy diabetica proliferans (rdp) is a type of retinopathy found in diabetics, characterized by proliferating connective tissue and newly formed vessels invading the ocular fundus. These vessels rupture easily causing haemorrhages into the vitreous. In cases where vitreous haemorrhages have made inspection of the fundus impossible a diagnosis of rdp is made. Connective tissue proliferation invading the fundus is found in several diseases and lesions, where retinal haemorrhages is the presenting sign. In diabetes, however, the proliferation may be the presenting sign (5, 29, 58).Ballantyne ( 5 ) discerns five types of diabetic retinopathy (rp). Of these the types 111, IV and V fall within the definition of rdp given above. Type I11 is characterized by venous changes, >>phlebosclerosisqc, and by newly formed vessels situated intra-and preretinally. Retinal haemorrhages are often seen in this type. In some places the veins, which are dilated and tortuous come near the retinal surface. Where this happens the membrana limitans interna is absent and the vessels become starting points for pre-retinal retia mirabilia and for vascular tufts growing into the vitreous.The types IV and V are more advanced forms of rdp. In everyone of these types primary connective tissue proliferations may occur. They grow out from the disc as thin webs in which delicate newly formed vessels are seen. When these rupture, they give rise to subhyaloid haemorrhages, sometimes invading the vitreous. At times the vascular proliferations dominate the fundus picture to such an extent that the term ,rubeosis retinae<< can be applied (56). T h e secondary proliferations occur when the haemorrhages are organized and replaced by fibrin and connective tissue. Some authors think (17, 20) that, as a rule, rdp starts with vitreous haemorrhages and that the formation of connective tissue and the appearance of new vessels are secondary phenomena.") Received Dec. 2nd 1957.
In 1859 Manz gave an account of some peculiar structures at the corneo-scleral junction in swine and, although their nature as true glands has been disputed, they have been called >>M anz' glands<<.According to Manz they were round vesicles with oval stomata, surrounded by a prominence. The inner wall of the vesicles was covered by epithelium. They contained large round cells and a fine granulated pulp. Most of the vesicles were situated on the nasal side of the cornea, some on the temporal side and only few at the upper and lower border of the cornea. Manz supposed, that they took part in the formation of the )>conjunctival humour<<. Later these structures were objects for investigations and considerations by many authors but with only slight success. As a consequence of faulty interpreations and misconceptions there has been a considerable confusion of ideas.Some authors even doubt their existence. Thus, Zietschniann (1906) did not find them in any animal. Others for instance Arnold (1862) and Henle (1863, 1873) deny categorically their existence and look upon )>the glands of Manzcc as wrongly apprehended sections of conjunctival folds. Other authors only speak about >>heaps of cells in limbar folds<< in swine, which show neither lumen nor other characteristics of *) Received June 2nd 19/18.
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