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Histology of Type 3 Macular Neovascularization and Microvascular Anomalies in Treated Age-Related Macular Degeneration

2023-09Artigo científico Acesso aberto
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dc.contributor.authorBerlin, Andreas
dc.contributor.authorCabral, Diogo
dc.contributor.authorChen, Ling
dc.contributor.authorMessinger, Jeffrey D.
dc.contributor.authorBalaratnasingam, Chandrakumar
dc.contributor.authorMendis, Randev
dc.contributor.authorFerrara, Daniela
dc.contributor.authorFreund, K. Bailey
dc.contributor.authorCurcio, Christine A.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblElsevier
dc.date.accessioned2023-04-03T22:15:50Z
dc.date.available2023-04-03T22:15:50Z
dc.date.issued2023-09
dc.descriptionOK Publisher Copyright: © 2023 American Academy of Ophthalmology
dc.description.abstractPurpose: To investigate intraretinal neovascularization and microvascular anomalies by correlating in vivo multimodal imaging with corresponding ex vivo histology in a single patient. Design: A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). Participants: A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Methods: Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Main Outcome Measures: Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Results: Six vascular lesions were histologically confirmed (type 3 MNV, n = 3; deep retinal age-related microvascular anomalies [DRAMAs], n = 3). Pyramidal (n = 2) or tangled (n = 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)–basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Conclusions: Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent8520162
dc.identifier.doi10.1016/j.xops.2023.100280
dc.identifier.issn2666-9145
dc.identifier.otherPURE: 57556790
dc.identifier.otherPURE UUID: ffd764db-2075-4259-b8b1-32984ded21bc
dc.identifier.otherScopus: 85150961252
dc.identifier.otherPubMed: 36970117
dc.identifier.urihttp://hdl.handle.net/10362/151550
dc.identifier.urlhttps://www.scopus.com/pages/publications/85150961252
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAge-related macular degeneration
dc.subjectDeep retinal age-related microvascular anomalies
dc.subjectHistopathology
dc.subjectType 3 macular neovascularization
dc.subjectVascular morphology
dc.subjectOphthalmology
dc.titleHistology of Type 3 Macular Neovascularization and Microvascular Anomalies in Treated Age-Related Macular Degenerationen
dc.title.subtitleA Case Studyen
dc.typejournal article
degois.publication.issue3
degois.publication.titleOphthalmology Science
degois.publication.volume3
dspace.entity.typePublication
rcaap.rightsopenAccess

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