Clinicopathologic Correlation of Anti-Vascular Endothelial Growth Factore-Treated Type 3 Neovascularization in Age-Related Macular Degeneration
Por:
Li M, Dolz-Marco R, Messinger JD, Wang L, Feist RM, Girkin CA, Gattoussi S, Ferrara D, Curcio CA and Freund KB
Publicada:
1 feb 2018
Ahead of Print:
27 sep 2017
Categoría:
Ophthalmology
Resumen:
Purpose: To correlate histologic results with previously recorded multimodal imaging results from a patient with type 3 neovascularization secondary to age-related macular degeneration (AMD).
Design: Case study, clinical imaging, laboratory imaging, and eye-tracked clinicopathologic correlation.
Participant: An 86-year-old white woman with type 3 neovascularization secondary to AMD treated with 6 intravitreal injections of bevacizumab.
Methods: Multimodal retinal imaging at each clinic visit was correlated with ex vivo and high-resolution histologic images of the preserved donor eye. Clinical imaging included serial near-infrared reflectance and eye-tracked spectral-domain OCT. Eye tracking, applied to the donor eye, enabled identification of histologic features corresponding to clinical OCT signatures.
Main Outcome Measures: Histologic correlates for clinical OCT signatures were sought, including reflectivity of the vascular complex, intraretinal hyperreflective foci and intraretinal cellularity, analysis of the topography of pathologic features, and evaluation of the suberetinal pigment epithelium (RPE) plus basal lamina (BL) space.
Results: Clinical imaging showed a deep neovascular lesion in close relationship with a mixed serous and drusenoid pigment epithelium detachment (PED), characteristic of type 3 neovascularization. Antiangiogenic therapy achieved a complete resolution of exudation. The PED progressively flattened with each treatment, leaving a persistent triangular hyperreflectivity in the outer retina. This persistent deep lesion histologically correlated with a vascular complex implanted into sub-RPE basal laminar deposit. No connection between the choriocapillaris and the sub-RPE plus BL space was observed. Both RPE-derived and lipid-filled cells were correlated with clinical intraretinal hyperreflective foci. The sub-RPE plus BL space contained macrophages, lymphocytes, Muller cell processes, and subducted RPE.
Conclusions: Clinicopathologic correlation of type 3 neovascularization showed vascular elements of retinal origin accompanied by collagenous material and Muller cell processes implanting into thick sub-RPE basal laminar deposit, which may simulate the appearance of chorioretinal anastomosis. Surrounding RPEderived and lipid-filled cells thought to be microglia correlated with clinical intraretinal hyperreflective foci. (C) 2017 by the American Academy of Ophthalmology
Filiaciones:
Li M:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
FISABIO Ophthalmology Medicine, Valencia, Spain
Messinger JD:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Wang L:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Feist RM:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Retina Consultants of Alabama, Birmingham, Alabama
Girkin CA:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Gattoussi S:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
Ferrara D:
Genentech, Inc, South San Francisco, California
Curcio CA:
Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Freund KB:
Vitreous Retina Macula Consultants of New York, New York, New York
LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
Department of Ophthalmology, New York University School of Medicine, New York, New York
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