Histopathologic and ultrastructural features of surgically excised subfoveal choroidal neovascular lesions: submacular surgery trials report no. 7.
Histopathologic and ultrastructural features of surgically excised subfoveal choroidal neovascular lesions: submacular surgery trials report no. 7.
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DOI：
10.1001/archopht.123.7.914
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发表时间：
2005-07
影响因子：
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通讯作者：
H. Grossniklaus;Päivi H. Miskala;W. Green;S. Bressler;B. Hawkins;C. Toth;David J. Wilson;N. Bressler
中科院分区：
文献类型：
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作者：
H. Grossniklaus;Päivi H. Miskala;W. Green;S. Bressler;B. Hawkins;C. Toth;David J. Wilson;N. Bressler
目的：明确黄斑下手术试验患者手术切除的中心凹下脉络膜新生血管病变的组织学和超微结构特征，并将其与临床数据进行比较。方法手术切除黄斑下手术试验N组患者的中心凹下脉络膜新生血管病变（病变主要为脉络膜新生血管[CNV]，有来自年龄相关性黄斑变性的经典CNV证据），B组试验（病变主要是年龄相关性黄斑变性出血性），和H组试验将1999年10月1日至2001年9月1日期间的10例（特发性中心凹下CNV或来自眼组织胞浆菌病综合征的中心凹下CNV）的病例提交给病理中心。病变生长模式（视网膜下色素上皮[sub-RPE]、视网膜下、合并或不确定）以及细胞和细胞外成分独立分类。将患者、眼睛和病变的人口统计学、临床和荧光素血管造影特征分别与病理特征进行比较。结果：在收集病理标本的24个月内，269例患者被分配到手术，199例研究眼的手术标本被提交给病理中心。在199例常规组织学标本中，144例（72%）被归类为CNV，51例（26%）为纤维细胞组织，4例（2%）为出血。H组（932 x 208 mum）的中位样本尺寸小于N组（1980 x 325 mum）和B组（1800 x 395 mum）。在199个标本中的91个（46%）中确定了CNV生长模式。在159个N组和B组病变中，76个（48%）具有不确定的生长模式，28个（18%）具有RPE下生长模式，33个（21%）具有RPE下和视网膜下生长模式。在40个H组病变中，32个（80%）具有不确定的生长模式，7个（18%）具有视网膜下生长模式，1个（2%）具有RPE下和视网膜下组合模式。基于电子显微镜，最常见的细胞病变成分是RPE、巨噬细胞、红细胞、纤维细胞和血管内皮;最常见的细胞外成分是24 nm胶原蛋白和纤维蛋白。在N组标本中，80%（40/50）和16%（8/49）的基底层和线性沉积物，在B组标本中分别为66%（43/65）和5%（3/65），在H组标本中分别为8%（2/26）和0%（0/26）。结论：大多数手术切除的中心凹下标本有CNV或与CNV相关的组织的证据。CNV中的成分与肉芽组织增生一致。手术切除的标本中存在基底沉积物提示临床诊断为年龄相关性黄斑变性，即使血液是病变的主要成分。视网膜色素上皮上方或下方的生长模式与经典或隐匿性CNV的荧光素血管造影模式的相关性有限，因为大多数标本没有足够的材料来确定这些模式。
OBJECTIVES To identify the histologic and ultrastructural features of surgically excised subfoveal choroidal neovascular lesions from patients enrolled in the Submacular Surgery Trials and to compare them with clinical data. METHODS Surgically excised subfoveal choroidal neovascular lesions from patients enrolled in the Submacular Surgery Trials group N trial (lesion predominantly choroidal neovascularization [CNV] with evidence of classic CNV from age-related macular degeneration), group B trial (lesion predominantly hemorrhagic from age-related macular degeneration), and group H trial (idiopathic subfoveal CNV or subfoveal CNV from ocular histoplasmosis syndrome) between October 1, 1999, and September 1, 2001, were submitted to the pathology center. The lesion growth pattern (subretinal pigment epithelial [sub-RPE], subretinal, combined, or indeterminate) and the cellular and extracellular constituents were classified independently. Demographic, clinical, and fluorescein angiographic characteristics of patients, eyes, and lesions, respectively, were compared with the pathologic features. RESULTS Of 269 patients assigned to surgery during the 24 months that pathologic specimens were collected, surgical specimens from study eyes of 199 were submitted to the pathology center. Of the 199 routine histologic specimens processed, 144 (72%) were classified as CNV, 51 (26%) as fibrocellular tissue, and 4 (2%) as hemorrhage. The median specimen size was smaller in group H (932 x 208 mum) than in groups N (1980 x 325 mum) and B (1800 x 395 mum). The CNV growth pattern was determined in 91 (46%) of 199 specimens. Of 159 group N and group B lesions, 76 (48%) had an indeterminate growth pattern, 28 (18%) had a sub-RPE growth pattern, and 33 (21%) had sub-RPE and subretinal growth patterns. Of 40 group H lesions, 32 (80%) had an indeterminate growth pattern, 7 (18%) had a subretinal growth pattern, and 1 (2%) had a combined sub-RPE and subretinal pattern. Based on electron microscopy, the most common cellular lesion components were RPE, macrophages, erythrocytes, fibrocytes, and vascular endothelium; the most common extracellular components were 24-nm collagen and fibrin. Basal laminar and linear deposits were found in 80% (40/50) and 16% (8/49) of group N specimens, 66% (43/65) and 5% (3/65) of group B specimens, and 8% (2/26) and 0% (0/26) of group H specimens, respectively. CONCLUSIONS Most surgically excised subfoveal specimens had evidence of CNV or tissue associated with CNV. The constituents in CNV were consistent with granulation tissue proliferation. The presence of basal deposits in surgically excised specimens suggested a clinical diagnosis of age-related macular degeneration, even when blood was the predominant component of the lesion. Correlation of growth patterns above or below the RPE with fluorescein angiographic patterns of classic or occult CNV was limited because most specimens had insufficient material to determine these patterns.