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Impressum
Immunohistochemical and electron microscopic findings of surgically excised choroidal neovascular membranes after photodynamic therapy
Schnurrbusch U. E. K., 1Welt C., 2Horn L.-C., Wiedemann P., Wolf S.
Klinik u. Poliklinik für Augenheilkunde, Liebigstr. 10-14, 04103 Leipzig, 1Inst. für Anatomie, Liebigstraße 13, 2Inst. für Pathologie, Liebigstr. 26
Objective: To investigate effects of photodynamic therapy (PDT)
on human choroidal neovascularization (CNV).
Methods: Three patients with age-related macular degeneration and
one patient with CNV secondary to pathologic myopia after PDT with verteporfin
underwent surgical extraction of the CNV. Immediately after excision the
CNV were divided for light microscopic (LM) and for electron microscopic
(EM) processing. For LM tissues were embedded in paraffin. Sections were
stained with hematoxylin, eosin, PAS-reaction as well as the immunohistochemistry
for Ki 67 and collagen typ III and IV. For EM the specimens were fixed
in glutaraldehyde and embedded in epoxy resin. Ultra-thin sections stained
with uranyl acetate and lead citrate were examined with a transmission
electron microscope.
Results: LM showed thick fibrovascular membranes. On the outer
surface remnants of retinal pigment epithelial (RPE) cells resting on
thickened inner aspect of Bruch`s membrane were found. Immunohistochemical
staining gave evidence of collagen type III and IV fibers within some
places and Ki 67 positive areas. The membrane showed areas with irregularly
shaped vessels. Some occluded vessels containing thrombotic masses and/or
ultrastructural damage of the neovascular endothelium im EM. Most vessels
presented regressive changes with vacuolization and fragmentation of the
neovascular endothelium accompanied with disintegration of the endothelial
cell layer. Occasionally there are vessels with normal or immature endothelium
containing intact red blood cells. At some locations the RPE cells were
metaplastic showing highly vacuolated cytoplasm.
Conclusions: The findings suggest, that the recurrences are related
to new vessel growth and re-canalization of occluded vessels as well as
inflammatory reactions.