Li Miaoling, Dolz-Marco Rosa, Messinger Jeffrey D, Sloan Kenneth R, Ferrara Daniela, Curcio Christine A, Freund K Bailey
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; Oftalvist Clinic, Valencia, Spain.
Ophthalmol Retina. 2019 Feb;3(2):99-111. doi: 10.1016/j.oret.2018.08.008. Epub 2018 Sep 5.
To correlate multimodal retinal imaging with high-resolution epoxy resin histologic analysis aligned to in vivo tomograms in a patient with exudative aneurysmal type 1 (AT1) neovascularization and hemorrhage secondary to age-related macular degeneration (AMD).
Case study and clinicopathologic correlation.
An 84-year-old man of European descent with AT1 neovascularization secondary to AMD with a 6-year follow-up with combined antiangiogenic and photodynamic therapy.
Multimodal imaging from each clinic visit, including fluorescein angiography, indocyanine green angiography, and OCT, was correlated with ex vivo OCT and high-resolution histologic images of the donor eye, aligned to the en face images showing hemorrhage and exudation.
Location of the branching vascular network and the aneurysmal vascular dilations in angiography, correlated with histologic findings.
Clinically, a hemorrhagic detachment of the retinal pigment epithelium (RPE) in the macular area was associated with an AT1 neovascularization extending near the optic nerve head, where the choroid, which was thin overall, was extremely thin. Resolution of the hemorrhage accompanied by progressive macular atrophy and internal changes in the reflectivity of the RPE detachment were observed. Histologic analysis suggested a physical continuity from a hyalinized choroidal artery to a capillary bed (branching vascular network) in the sub-RPE-basal lamina (BL) space without visualization of aneurysmal dilations.
Clinicopathologic correlation of AT1 neovascularization from an intact treated eye with dye-based angiographic and OCT scans supports the proposed nomenclature of AT1 neovascularization over polypoidal choroidal vasculopathy. We described continuity of the sub-RPE-BL branching vascular network with choroidal arteries and histologic correlates of common OCT signatures of neovascular AMD. The thinness of choroid in this patient of European descent contrasts with that reported for Asian populations, in which AT1 neovascularization is associated commonly with pachychoroid disease characteristics. This case reinforces the different manifestations of AT1 neovascularization across and within diverse ethnicities and diseases.
将多模态视网膜成像与高分辨率环氧树脂组织学分析相关联，该分析与一名患有渗出性1型（AT1）新生血管形成及年龄相关性黄斑变性（AMD）继发出血患者的体内断层扫描对齐。
病例研究及临床病理相关性研究。
一名84岁的欧洲裔男性，患有AMD继发的AT1新生血管形成，接受抗血管生成和光动力联合治疗并随访6年。
每次临床就诊时的多模态成像，包括荧光素血管造影、吲哚菁绿血管造影和光学相干断层扫描（OCT），与供体眼的离体OCT及高分辨率组织学图像相关联，这些图像与显示出血和渗出的正面图像对齐。
血管造影中分支血管网络和动脉瘤样血管扩张的位置，与组织学结果相关。
临床上，黄斑区视网膜色素上皮（RPE）的出血性脱离与延伸至视神经乳头附近的AT1新生血管形成相关，此处脉络膜整体较薄，极度菲薄。观察到出血消退，伴有黄斑逐渐萎缩以及RPE脱离反射率的内部变化。组织学分析表明，在RPE下基底膜（BL）空间中，从玻璃样变的脉络膜动脉到毛细血管床（分支血管网络）存在物理连续性，未观察到动脉瘤样扩张。
对一只完整治疗眼的AT1新生血管形成进行基于染料的血管造影和OCT扫描的临床病理相关性研究，支持了AT1新生血管形成相对于息肉状脉络膜血管病变的命名。我们描述了RPE下BL分支血管网络与脉络膜动脉的连续性以及新生血管性AMD常见OCT特征的组织学相关性。该欧洲裔患者脉络膜的菲薄与亚洲人群报道的情况形成对比，在亚洲人群中，AT1新生血管形成通常与厚脉络膜疾病特征相关。该病例强化了AT1新生血管形成在不同种族和疾病之间及内部的不同表现。
