Phthisis bulbi--an intraocular fluoride proliferative reaction.

This study reports the findings in 74 mainly posttraumatic phthisical human eyes enucleated after varying time intervals. It was usually a result of severe anterior segment injury with marked intraocular hemorrhage and tissue damage. In summary, the tissue reactions in these eyes are those known from wound healing elsewhere in the body with additional traction changes and ocular hypotension. In phthisis bulbi the complex reactions associated with inflammatory, healing, and scarring processes reach a maximum within the first 3 months, but can go on for years. Cell proliferation and transformation are early and important features of this process which lead to retinal and ciliochoroidal detachment, hypotension and marked shrinkage of the globe. The results also indicate that reactions initiated by intraocular hemorrhages have an important part in the development of phthisis bulbi. The process of phthisis bulbi is a process of wound healing in the sense of an intraocular fluoride proliferative reaction. Main areas of proliferation are the pars plana of the ciliary body, the optic disc and the base of the iris. Finally degenerative changes will develop additionally. It appears that repair of the injured tissues with early primary (within 6 h) and secondary (within the first 2 weeks) intraocular surgery and other preventive surgical measures should be performed by an experienced surgeon. Further work on postoperative medical treatment to control the secondary reactions is needed. To compare the therapeutic efforts a 5-stage classification is proposed.