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. 2001 Sep;85(9):1086–1091. doi: 10.1136/bjo.85.9.1086

Histological findings of surgically excised choroidal neovascular membranes after photodynamic therapy

U Schnurrbusch 1, K Welt 1, L Horn 1, P Wiedemann 1, S Wolf 1
PMCID: PMC1724112  PMID: 11520762

Abstract

AIM—To investigate effects of photodynamic therapy (PDT) on human choroidal neovascularisation (CNV).
METHODS—Two patients with recurrences after PDT with verteporfin underwent surgical extraction of the CNV. Immediately after surgical excision the subfoveal neovascular membranes were divided for light microscopic and for electron microscopic processing. For light microscopy tissues were embedded in paraffin. Sections were stained with haematoxylin and eosin, and the periodic acid Schiff (PAS) reaction was performed to determine histological diagnosis and to ensure tissue quality. For electron microscopy the specimens were fixed in glutaraldehyde and embedded in epoxy resin. Semithin sections were stained with uranyl acetate and lead citrate and examined with a transmission electron microscope.
RESULTS—Light microscopy showed thick fibrovascular membranes in both cases. On the outer surface remnants of retinal pigment epithelial cells resting on thickened inner aspect of Bruch's membrane were found. On the retinal side some outer segments were found. The membrane showed areas with irregularly shaped vessels. Electron photomicrographs showed occluded vessels within the CNV containing thrombotic masses and/or ultrastructural damage of the neovascular endothelium. Most of the vessels presented regressive changes with vacuolisation and fragmentation of the neovascular endothelium accompanied by disintegration of the endothelial cell layer. Extravasation of red blood cells was observed. Occasionally, vessels with normal endothelium containing intact red blood cells were observed. Some vessels contained immature endothelial cells. At some locations the retinal pigment epithelium cells (RPE) were metaplastic showing highly vacuolised cytoplasm.
CONCLUSIONS—These findings suggest that the evidence of fluorescein leakage from the CNV and enlargement of the neovascular complex following PDT could be related to new vessel growth and recanalisation of occluded vessels. Additionally, RPE disturbances were observed in the specimens. This finding may be related to the original pathology or could indicate that PDT treatment may result in RPE atrophy.



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Figure 1  .

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Angiographic studies before PDT treatment (patient 1) He had stable fixation within the area of new vessels visible in the early angiographic study. (A) Early phase angiogram. (B) Late phase angiogram.

Figure 2  .

Figure 2  

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Angiographic studies after PDT (patient 1) (A) Early phase angiogram demonstrating a marked enlargement of the neovascular complex. (B) Mid-phase angiogram.

Figure 3  .

Figure 3  

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(A) General view of CNV after PDT represents hyaline masses between retinal pigment epithelium and fibrovascular tissue with severe oedema (haematoxylin and eosin staining, ×100). (B) The hyalinised masses in the CNV were partly surrounded by small red cell containing vessels partly invading the CNV (haematoxylin and eosin ×400).

Figure 4  .

Figure 4  

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Capillary with structurally damaged endothelium and part of an pericyte. Note the fibrin, debris, and the erythrocyte in the lumen of the vessel.

Figure 5  .

Figure 5  

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Capillary with structurally damaged endothelium and part of a pericyte. The lumen contains lots of fibrin and debris. Additionally, cellular debris can be seen in the matrix around the vessel.

Figure 6  .

Figure 6  

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Part of a CNV membrane after PDT containing a damaged microvessel. The endothelium shows excessive bubbling and partly total loss of continuity.

Figure 7  .

Figure 7  

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The endothelium with split basal lamina, structural disintegration, and loss of continuity; further margination of condensed chromatine of the nucleus. Note the extravasated red blood cells. An erythrocyte just penetrates the endothelium.

Figure 8  .

Figure 8  

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Retinal pigment epithelial cells characterised by numerous lipofuscin and melanolipofuscin, and lancet-shaped melanin granules. Note the vacuolated cytoplasma.

Figure 9  .

Figure 9  

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Part of a dehiscent blood vessel showing isolated remnants of endothelium. Loosely arranged collagen fibrils are found outside the basal membrane.

Figure 10  .

Figure 10  

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General view of CNV after PDT with a major subretinal fibrovascular component. Membrane contains hyaline masses between retinal pigment epithelium and fibrovascular tissue with severe oedema (PAS reaction, ×200).

Figure 11  .

Figure 11  

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Thrombotic capillary with structurally damaged endothelium and pericyte of a CNV after PDT. Note the fibrin and debris in the lumen and the split basal lamina. Cellular debris is also in the fibrillar matrix around the vessel.

Figure 12  .

Figure 12  

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Immature capillary of a CNV after PDT. The endothelium contains abundant rough endoplasmic reticulum, some intact mitochondria, and a thin basal lamina. Collagen fibrils and parts of fibroblasts surrounding the vessel.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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