Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany.
Retina. 2023 Nov 1;43(11):1904-1913. doi: 10.1097/IAE.0000000000003881.
Imaging indicators of macular neovascularization risk can help determine patient eligibility for new treatments for geographic atrophy secondary to age-related macular degeneration. Because type 1 macular neovascularization includes inflammation, we assessed by histology the distribution of cells with inflammatory potential in two fellow eyes with age-related macular degeneration.
Two eyes of a White woman in her 90's with type 3 macular neovascularization treated with antivascular endothelial growth factor were prepared for high-resolution histology. Eye-tracked spectral domain optical coherence tomography applied to the preserved donor eyes linked in vivo imaging to histology. Cells were enumerated in the intraretinal, subretinal, and subretinal retinal pigment epithelium (RPE)-basal lamina compartments on 199 glass slides. Cells with numerous organelles were considered to RPE-derived; cells with sparse RPE organelles were considered non-RPE phagocytes.
Both eyes had soft drusen and abundant subretinal drusenoid deposit. In the retina and subretinal space, RPE-derived cells, including hyperreflective foci, were common (n = 125 and 73, respectively). Non-RPE phagocytes were infrequent (n = 5 in both). Over drusen, RPE morphology transitioned smoothly from the age-normal layer toward the top, suggesting transdifferentiation. The sub-RPE-basal lamina space had RPE-derived cells (n = 87) and non-RPE phagocytes (n = 49), including macrophages and giant cells.
Numerous sub-RPE-basal lamina cells of several types are consistent with the documented presence of proinflammatory lipids in drusen and aged Bruch's membrane. The relatively compartmentalized abundance of infiltrating cells suggests that drusen contents are more inflammatory than subretinal drusenoid deposit, perhaps reflecting their environments. Ectopic RPE occurs frequently. Some manifest as hyperreflective foci. More cells may be visible as optical coherence tomography technologies evolve.
有助于确定黄斑新生血管风险的影像学指标，可帮助确定是否适合接受新的治疗方法来治疗年龄相关性黄斑变性引起的地图状萎缩。由于 1 型黄斑新生血管包括炎症，我们通过组织学评估了 2 例年龄相关性黄斑变性伴 3 型黄斑新生血管患者的两只同眼具有炎症潜能的细胞分布。
对 1 例 90 多岁白人女性的 2 只眼进行了 3 型黄斑新生血管的抗血管内皮生长因子治疗，并用高分辨率组织学准备。将保存在供体眼中的眼跟踪谱域光学相干断层扫描应用于活体成像与组织学联系起来。在 199 张载玻片上对视网膜内、视网膜下和视网膜色素上皮（RPE）-基底膜腔室中的细胞进行计数。具有大量细胞器的细胞被认为是 RPE 衍生的；细胞器稀疏的细胞被认为是非 RPE 吞噬细胞。
两只眼均有软玻璃膜疣和大量的视网膜下玻璃膜疣沉积物。在视网膜和视网膜下空间中，RPE 衍生细胞（包括高反射焦点）很常见（分别为 125 个和 73 个）。非 RPE 吞噬细胞很少（各 5 个）。在玻璃膜疣上，RPE 形态从正常年龄层平滑过渡到顶部，提示转分化。RPE 下基底膜腔室中有 RPE 衍生细胞（n = 87）和非 RPE 吞噬细胞（n = 49），包括巨噬细胞和巨细胞。
大量的 RPE 下基底膜腔室中的多种类型细胞与文献报道的玻璃膜疣和老化 Bruch 膜中存在的促炎脂质一致。浸润细胞相对分隔的丰富程度表明，玻璃膜疣内容物比视网膜下玻璃膜疣沉积物更具炎症性，这可能反映了它们的环境。异位 RPE 很常见。有些表现为高反射焦点。随着光学相干断层扫描技术的发展，可能会有更多的细胞可见。
