Eye Pathology in Nephrogenic Systemic Fibrosis
JL Abraham, AE Barker-Griffith. SUNY Upstate Medical University, Syracuse, NY
Background: Nephrogenic Systemic Fibrosis, first described in 2000, is a debilitating cutaneous and systemic fibrosing disorder. The two known associations with NSF include renal dysfunction and exposure to gadolinium-containing contrast agents (GCCA). Ophthalmic interest stems from the appearance of “scleral injection” in all cases reported by Levine et al and scleral plaques seen clinically in young persons with NSF.
Design: We have reported detection by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDS) of gadolinium in paraffin embedded skin biopsies of NSF tissue in over 60 cases and a few autopsy cases. Only recently have two autopsy cases included the eyes. These are studied by (SEM-EDS) for evidence of gadolinium and scleral plaques.
Results: SEM-EDS show the scleral plaques to be composed entirely of calcium phosphate with no detectable gadolinium in any of these areas. Gadolinium was discovered around and in blood vessels of the choriocapillaris. In addition, the light microscopy of the scleral plaques are very different from the usual Cogan's plaques of aging.
Conclusions: The scleral plaques observed in NSF may be related more to calcium-phosphorous metabolism disturbances of chronic renal failure and hyperparathyroidism than to specific gadolinium toxicity.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 263, Wednesday Afternoon