SEM and TEM analyses of isolated human retinal microvessel basement membranes in diabetic retinopathy.

Human retinas from persons with diabetic retinopathy and age-matched controls were rendered acellular by sequential detergent treatment. The resulting network of microvascular extracellular matrix (ECM) materials, including basement membranes (BMs), was compared by TEM and, following cryofracture, by SEM. Our study demonstrates that in diabetics, retinal capillary BM complexes are generally thickened and that their ECM subcomponents, including BM leaflets and BM-like pericytic matrix (PCM), are differentially altered. Two diabetic microvessel types were identified. In type A vessels, ECM expansion is manifested by loosely arranged combinations of concentric PCM layers and collagen fibrils with thickened subendothelial (EBM) and pericyte (PBM) BM leaflets. Type B vessels show densely compact central PCM masses and poorly recognizable EBMs and PBMs. In both types, Müller cell BMs (MBMs) are relatively unaffected. High-resolution SEM shows tissue-specific features in normal EBM and MBM surfaces, but disease-related topographic changes are not evident. It is possible that the ECM arrangements identified in our study relate to different microvessel domains and that their specific morphological features may play important roles in the pathogenesis of diabetic retinopathy including capillary closure and neovascularization.