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.
Ophthalmology. 2018 Feb;125(2):276-287. doi: 10.1016/j.ophtha.2017.08.019. Epub 2017 Sep 28.
To correlate histologic results with previously recorded multimodal imaging results from a patient with type 3 neovascularization secondary to age-related macular degeneration (AMD).
Case study, clinical imaging, laboratory imaging, and eye-tracked clinicopathologic correlation.
An 86-year-old white woman with type 3 neovascularization secondary to AMD treated with 6 intravitreal injections of bevacizumab.
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.
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 sub-retinal pigment epithelium (RPE) plus basal lamina (BL) space.
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, Müller cell processes, and subducted RPE.
Clinicopathologic correlation of type 3 neovascularization showed vascular elements of retinal origin accompanied by collagenous material and Müller cell processes implanting into thick sub-RPE basal laminar deposit, which may simulate the appearance of chorioretinal anastomosis. Surrounding RPE-derived and lipid-filled cells thought to be microglia correlated with clinical intraretinal hyperreflective foci.
将患者 3 型新生血管化的组织学结果与先前记录的多模态成像结果相关联，该患者继发于年龄相关性黄斑变性（AMD）。
病例研究、临床成像、实验室成像和眼跟踪临床病理相关性研究。
一位 86 岁白人女性，患有继发于 AMD 的 3 型新生血管化，接受了 6 次玻璃体内贝伐单抗注射治疗。
在每次就诊时，对多模态视网膜成像进行了与保存的供体眼的离体和高分辨率组织学图像的相关性分析。临床成像包括连续近红外反射率和眼跟踪光谱域 OCT。应用于供体眼的眼跟踪技术能够识别与临床 OCT 特征相对应的组织学特征。
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、视网膜内高反射性焦点和视网膜内细胞密度、病理性特征的拓扑分析以及视网膜下色素上皮（RPE）加基底膜（BL）空间的评估。
临床成像显示一个与混合浆液性和渗出性色素上皮脱离（PED）密切相关的深层新生血管病变，这是 3 型新生血管化的特征。抗血管生成治疗完全消退了渗出物。PED 在每次治疗后逐渐变平，在外视网膜留下一个持久的三角形高反射性。这种持续的深层病变在组织学上与植入 RPE 下 BL 沉积物中的血管复合体相关。没有观察到脉络膜毛细血管与 RPE 下加 BL 空间之间的连接。RPE 衍生细胞和富含脂质的细胞都与临床视网膜内高反射性焦点相关。RPE 下加 BL 空间包含巨噬细胞、淋巴细胞、Müller 细胞突起和下推的 RPE。
3 型新生血管化的临床病理相关性研究显示，起源于视网膜的血管成分伴有胶原物质和 Müller 细胞突起植入增厚的 RPE 下 BL 沉积物中，这可能模拟脉络视网膜吻合的外观。周围的 RPE 衍生细胞和富含脂质的细胞，被认为是小胶质细胞，与临床视网膜内高反射性焦点相关。
