Ocular changes in the Shwartzman reaction. Their possible relationship to diabetic retinopathy.

Abstract

The generalized Shwartzman reaction is produced, classically, in rabbits by 2 appropriately-spaced intravenous injections of Gram-negative bacterial endotoxin and is characterized by the precipitation of eosinophilic, periodic acid-Schiff (PAS)-positive material in the vasculature of many organs including kidney, liver, lung, and spleen.2,3There often occurs in this reaction glomerular capillary dilatation and the deposition within such capillaries of PAS-positive material.4This finding suggested the possibility of similar dilatations in the retinal capillaries in the generalized Shwartzman reaction. The appearance of the glomeruli in the generalized Shwartzman reaction (Fig. 1) suggests similarity to that described in the Kimmelstiel-Wilson lesion5(Fig. 2). There is evidence for the coincidence of retinopathy and the Kimmelstiel-Wilson lesion in diabetes mellitus.6,7In diabetic retinopathy aneurysmal dilatations are found on both the venous and arterial sides of the capillaries and, less frequently, in small veins. The aneurysms may be mere out-pouchings of the