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Histological-angiographical Correlation of Different Types of Exudative AMD
1Hermans P., 1Lommatzsch A., 1Spital G., 2Bornfeld N., 1Pauleikhoff D.,
1St. Franziskus-Hospital, Augenabteilung (Münster)
2Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde, Abt. Hinterer Augenabschnitt (Essen)
Purpose: The goal of the present study was to investigate the histological architecture of different types of exudative AMD and to correlate the results with the fluorescein angiographical (FA) diagnosis.
Methods: After macular translocation surgery 34 different specimens from patients with exudative AMD were investigated by lightmicroscopy (PAS and HE staining). The histological results and specific morphological characteristics were correlated with the fluorescein angiographical classification (14 pat. with classic choroidal neovascularisation (CNV),11 pat. with occult CNV without serous pigmentepithelium detachment (PED), 6 pat. with occult CNV with serous PED, 4 lesions of occult CNV with large subretinal hemorrhages).
Results: The classification by FA matched in all cases the histologic appearance. The most striking feature in classic CNV were subretinal fibrovascular membranes. Additional different amounts of fibrovascular tissue were located below the RPE (additional occult CNV). Fibrovascular tissue underlying the RPE was the main component of occult CNV. In occult CNV with serous PED (vascularized PED) two histologic archictures were prominent. In three cases wide RPE detachments from an underlying fibrovascular membrane were visible, while in three other cases the RPE was detached and rolled up, and fibrocytes were more or less absent. In specimens with large subretinal hemorrhages also fibrovascular membranes covered by RPE cells were visible (ass. occult CNV).
Conclusion: The histological examination of different types of exudative AMD showed differences in the histologic architecture, which were consistent with the FA classification. Angiographically differentiated classic CNV were associated with subretinal location of the CNV above the RPE, while in occult CNV with or without serous PED the CNV developed between the RPE and the outer layers of Bruch´s Membrane. In occult CNV with serous PED the covering RPE was additionally separated from the RPE by serous fluid or the RPE was rolled up.