Clinicopathologic Correlation of Anti-Vascular Endothelial Growth Factore-Treated Type 3 Neovascularization in Age-Related Macular Degeneration
Clinicopathologic Correlation of Anti-Vascular Endothelial Growth Factore-Treated Type 3 Neovascularization in Age-Related Macular Degeneration
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DOI：
10.1016/j.ophtha.2017.08.019
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发表时间：
2018-02-01
期刊：
影响因子：
13.7
通讯作者：
Freund, K. Bailey
中科院分区：
文献类型：
--
作者：
Li, Miaoling;Dolz-Marco, Rosa;Freund, K. Bailey
目的：将组织学结果与先前记录的继发于年龄相关性黄斑变性（AMD）的3型新血管形成患者的多模态成像结果相关联。设计：病例研究，临床成像，实验室成像和眼跟踪临床病理学相关性。参与者：一名86岁的白色女性，继发于AMD的3型新血管形成，接受6次玻璃体内注射贝伐单抗治疗。方法：在每次临床访视时的多模式视网膜成像与保存的供体眼的离体和高分辨率组织学图像相关。临床成像包括连续近红外反射率和眼跟踪光谱域OCT。眼跟踪应用于供体眼，能够识别与临床OCT特征相对应的组织学特征。主要结果测量：寻找临床OCT特征的组织学相关性，包括血管复合体的反射率、视网膜内高反射灶和视网膜内细胞结构，病理特征的地形图分析，结果：临床影像学表现为深部新生血管性病变，伴浆液性和核膜样色素上皮脱离（PED），表现为3型新生血管。抗血管生成治疗实现了渗出的完全解决。PED随着每次治疗逐渐变平，在外层视网膜中留下持续的三角形超反射。这种持续性深部病变在组织学上与植入RPE下基底层存款的血管复合体相关。脉络膜毛细血管与RPE下间隙和BL间隙之间无联系。RPE衍生细胞和脂质填充细胞与临床视网膜内高反射灶相关。亚RPE加上BL空间包含巨噬细胞，淋巴细胞，Muller细胞的过程，和subductedRPE.Conclusions：3型新生血管的临床病理相关性显示视网膜起源的血管成分伴随着胶原材料和Muller细胞的过程植入厚的亚RPE基底层存款，这可能模拟的外观脉络膜视网膜吻合。周围RPE衍生和充满脂质的细胞被认为是小胶质细胞，与临床视网膜内高反射灶相关。(C)2017年美国眼科学会
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