Skalet Alison H, Miller Audra K, Klein Michael L, Lauer Andreas K, Wilson David J
Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
Retina. 2017 Aug;37(8):1620-1624. doi: 10.1097/IAE.0000000000001672.
To describe histopathologic features of an eye with retinal angiomatous proliferation (RAP) secondary to age-related macular degeneration treated with serial ranibizumab injections and to correlate these findings with spectral domain optical coherence tomography.
Histopathologic features from serial sections through the globe of a 93-year-old man with age-related macular degeneration were studied and compared with spectral domain optical coherence tomography images obtained 7 weeks before his death.
The pathologic correlate of ranibizumab-treated RAP was a circumscribed, branching paucicellular vascular complex extending from the inner plexiform layer to Bruch membrane. The histopathologic findings corresponded to an area of hyperreflectivity on spectral domain optical coherence tomography imaging, substantiating the reported tomographic appearance of RAP lesions. A frank anastomosis with choroidal or retinal vasculature was not seen in this treated RAP lesion. There was a lack of retinal pigment epithelium underlying the lesion in an area of retinal pigment epithelium detachment. The elastic portion of Bruch membrane appeared intact. Treatment with ranibizumab over an extended period of time may have been associated with a loss of cellularity of the RAP lesion.
In a patient with ARMD extensively treated with ranibizumab, color fundus photography, fluorescein angiography and SD-OCT images of RAP correlated histopathologically with a paucicellular intraretinal vascular complex.
描述一名患有年龄相关性黄斑变性继发视网膜血管瘤样增殖(RAP)的患者,在接受雷珠单抗系列注射治疗后的眼部组织病理学特征,并将这些发现与光谱域光学相干断层扫描结果相关联。
对一名93岁患有年龄相关性黄斑变性男性患者眼球连续切片的组织病理学特征进行研究,并与他死亡前7周获得的光谱域光学相干断层扫描图像进行比较。
雷珠单抗治疗的RAP的病理对应表现为一个界限清楚的、分支状的少细胞血管复合体,从内丛状层延伸至布鲁赫膜。组织病理学发现与光谱域光学相干断层扫描成像上的高反射区相对应,证实了所报道的RAP病变的断层扫描表现。在这个经治疗的RAP病变中未见到与脉络膜或视网膜血管的明显吻合。在视网膜色素上皮脱离区域的病变下方缺乏视网膜色素上皮。布鲁赫膜的弹性部分看起来完整。长期使用雷珠单抗治疗可能与RAP病变的细胞减少有关。
在一名接受雷珠单抗广泛治疗的年龄相关性黄斑变性患者中,RAP的彩色眼底照相、荧光素血管造影和光谱域光学相干断层扫描图像在组织病理学上与少细胞视网膜内血管复合体相关。