Castellarin A A, Sugino I K, Nasir M, Zarbin M A
Department of Ophthalmology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-2499, USA.
Br J Ophthalmol. 1997 Nov;81(11):994-1000. doi: 10.1136/bjo.81.11.994.
AIMS/BACKGROUND: To correlate the histopathology of an excised choroidal neovascular membrane (CNV) with the clinical and angiographic findings in a 32-year-old woman with pseudotumour cerebri and a peripapillary CNV with subfoveal extension.
The patient's visual acuity was assessed by individuals experienced in low vision refraction and who were not members of the surgical team. The CNV was excised via a conventional three port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FAs) and fundus photographs were obtained to study the dissection bed.
One week after surgery, the FA showed mottled subfoveal choriocapillaris perfusion. Three weeks after surgery, this area showed retinal pigment epithelium (RPE) atrophy clinically, and the FA showed choriocapillaris non-perfusion. Six months after surgery, the area of RPE atrophy and the corresponding area of choriocapillaris non-perfusion had expanded. Histologically, the excised CNV disclosed hyperplastic RPE, fibrovascular tissue, and no choriocapillaris. Fragments of RPE basement were present along the external edge of the specimen. The patient's visual acuity did not improve significantly after surgery.
Choriocapillaris non-perfusion can develop even in young patients following CNV excision. In this particular case, it is believed that choriocapillaris atrophy was caused by incomplete ingrowth of RPE into the dissection bed following RPE removal with CNV excision. As far as is known, this is the first report describing the results of surgery for CNV secondary to papilloedema associated with pseudotumour cerebri.
目的/背景：在一名患有假性脑瘤且伴有黄斑中心凹下延伸的视乳头周围脉络膜新生血管（CNV）的32岁女性中，将切除的脉络膜新生血管膜（CNV）的组织病理学与临床及血管造影结果进行关联。
患者的视力由低视力验光经验丰富且非手术团队成员的人员评估。通过常规三通道玻璃体切除术及视网膜下剥离切除CNV。切除的组织进行光镜和电镜研究。获取术前及术后系列荧光素血管造影（FA）和眼底照片以研究剥离床。
术后1周，FA显示黄斑中心凹下脉络膜毛细血管灌注斑驳。术后3周，该区域临床显示视网膜色素上皮（RPE）萎缩，FA显示脉络膜毛细血管无灌注。术后6个月，RPE萎缩区域及相应的脉络膜毛细血管无灌注区域扩大。组织学上，切除的CNV显示RPE增生、纤维血管组织，且无脉络膜毛细血管。标本外缘有RPE基底膜碎片。患者术后视力无明显改善。
即使在年轻患者中，CNV切除术后也可能发生脉络膜毛细血管无灌注。在该特定病例中，据信脉络膜毛细血管萎缩是由于CNV切除时RPE切除后RPE向剥离床内生长不完全所致。据所知，这是第一份描述与假性脑瘤相关的视乳头水肿继发CNV手术结果的报告。
