Clinicopathologic correlation of choroidal and retinal neovascular lesions in age-related macular degeneration

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Abstract

Purpose To describe histopathologic findings in donor eyes of 3 individuals with neovascular age-related macular degeneration and to correlate with results of clinical and fluorescein angiographic studies performed before death. Design Retrospective, observational case series. Methods Three eyes of 3 individuals with neovascular age-related macular degeneration were obtained after death and were prepared for histopathologic examination at a tertiary care referral center. Serial sections through the macula and optic nerve were evaluated with light microscopy. Findings were correlated with results of clinical evaluation, including findings of fluorescein angiography performed from 1 week to 5 months before death. Results In Case 1, histopathologic examination revealed a thin choroidal neovascular membrane beneath a relatively intact retinal pigment epithelium (type 1 neovascularization). This correlated with an occult choroidal neovascular membrane on fluorescein angiography characterized by a stippled appearance with minimal late leakage, representing possibly the earliest clinically detectable neovascular membrane for which histopathologic correlation is available. In Case 2, histopathologic examination demonstrated subfoveal choroidal neovascularization with distinctly separate subretinal pigment epithelial (type 1) and subretinal (type 2) components, correlating to fluorescein angiographic appearance of a mixed neovascular membrane with corresponding occult and classic features. The histopathologic findings in Case 3 revealed a plexus of blood vessels in the outer retina surrounded by an abundant eosinophiolic extracellular matrix and associated with a pigment epithelial detachment. There was no communication with the choroid. This correlated with clinical findings of retinal angiomatous proliferation. Conclusions These 3 in situ clinicopathologic correlative studies add new knowledge of the broad clinical spectrum of neovascular age-related macular degeneration.

Original languageEnglish (US)
Pages (from-to)161-169
Number of pages9
JournalAmerican Journal of Ophthalmology
Volume151
Issue number1
DOIs
StatePublished - Jan 2011

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Macular Degeneration
Membranes
Fluorescein Angiography
Fluorescein
Tertiary Care Centers
Choroidal Neovascularization
Choroid
Retinal Pigment Epithelium
Optic Nerve
Extracellular Matrix
Blood Vessels
Retina
Microscopy
Light

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "Clinicopathologic correlation of choroidal and retinal neovascular lesions in age-related macular degeneration",
abstract = "Purpose To describe histopathologic findings in donor eyes of 3 individuals with neovascular age-related macular degeneration and to correlate with results of clinical and fluorescein angiographic studies performed before death. Design Retrospective, observational case series. Methods Three eyes of 3 individuals with neovascular age-related macular degeneration were obtained after death and were prepared for histopathologic examination at a tertiary care referral center. Serial sections through the macula and optic nerve were evaluated with light microscopy. Findings were correlated with results of clinical evaluation, including findings of fluorescein angiography performed from 1 week to 5 months before death. Results In Case 1, histopathologic examination revealed a thin choroidal neovascular membrane beneath a relatively intact retinal pigment epithelium (type 1 neovascularization). This correlated with an occult choroidal neovascular membrane on fluorescein angiography characterized by a stippled appearance with minimal late leakage, representing possibly the earliest clinically detectable neovascular membrane for which histopathologic correlation is available. In Case 2, histopathologic examination demonstrated subfoveal choroidal neovascularization with distinctly separate subretinal pigment epithelial (type 1) and subretinal (type 2) components, correlating to fluorescein angiographic appearance of a mixed neovascular membrane with corresponding occult and classic features. The histopathologic findings in Case 3 revealed a plexus of blood vessels in the outer retina surrounded by an abundant eosinophiolic extracellular matrix and associated with a pigment epithelial detachment. There was no communication with the choroid. This correlated with clinical findings of retinal angiomatous proliferation. Conclusions These 3 in situ clinicopathologic correlative studies add new knowledge of the broad clinical spectrum of neovascular age-related macular degeneration.",
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AB - Purpose To describe histopathologic findings in donor eyes of 3 individuals with neovascular age-related macular degeneration and to correlate with results of clinical and fluorescein angiographic studies performed before death. Design Retrospective, observational case series. Methods Three eyes of 3 individuals with neovascular age-related macular degeneration were obtained after death and were prepared for histopathologic examination at a tertiary care referral center. Serial sections through the macula and optic nerve were evaluated with light microscopy. Findings were correlated with results of clinical evaluation, including findings of fluorescein angiography performed from 1 week to 5 months before death. Results In Case 1, histopathologic examination revealed a thin choroidal neovascular membrane beneath a relatively intact retinal pigment epithelium (type 1 neovascularization). This correlated with an occult choroidal neovascular membrane on fluorescein angiography characterized by a stippled appearance with minimal late leakage, representing possibly the earliest clinically detectable neovascular membrane for which histopathologic correlation is available. In Case 2, histopathologic examination demonstrated subfoveal choroidal neovascularization with distinctly separate subretinal pigment epithelial (type 1) and subretinal (type 2) components, correlating to fluorescein angiographic appearance of a mixed neovascular membrane with corresponding occult and classic features. The histopathologic findings in Case 3 revealed a plexus of blood vessels in the outer retina surrounded by an abundant eosinophiolic extracellular matrix and associated with a pigment epithelial detachment. There was no communication with the choroid. This correlated with clinical findings of retinal angiomatous proliferation. Conclusions These 3 in situ clinicopathologic correlative studies add new knowledge of the broad clinical spectrum of neovascular age-related macular degeneration.

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