Clinicopathologic Correlation of Choroidal and Retinal Neovascular Lesions in Age-Related Macular Degeneration

PURPOSE: To describe histopathologic findings in donor eyes of 3 individuals with neovascular age-related macular degeneration and to correlate with results of clinical and fluorescein angiographic studies performed before death. DESIGN: Retrospective, observational case series. METHODS: Three eyes of 3 individuals with neovascular age-related macular degeneration were obtained after death and were prepared for histopathologic examination at a tertiary care referral center. Serial sections through the macula and optic nerve were evaluated with light microscopy. Findings were correlated with results of clinical evaluation, including findings of fluorescein angiography performed from 1 week to 5 months before death. RESULTS: In Case 1, histopathologic examination revealed a thin choroidal neovascular membrane beneath a relatively intact retinal pigment epithelium (type 1 neovascularization). This correlated with an occult choroidal neovascular membrane on fluorescein angiography characterized by a stippled appearance with minimal late leakage, representing possibly the earliest clinically detectable neovascular membrane for which histopathologic correlation is available. In Case 2, histopathologic examination demonstrated subfoveal choroidal neovascularization with distinctly separate subretinal pigment epithelial (type 1) and subretinal (type 2) components, correlating to fluorescein angiographic appearance of a mixed neovascular membrane with corresponding occult and classic features. The histopathologic findings in Case 3 revealed a plexus of blood vessels in the outer retina surrounded by an abundant eosinophiolic extracellular matrix and associated with a pigment epithelial detachment. There was no communication with the choroid. This correlated with clinical findings of retinal angiomatous proliferation. CONCLUSIONS: These 3 in situ clinicopathologic correlative studies add new knowledge of the broad clinical spectrum of neovascular age-related macular degeneration. (Am J Ophthalmol 2011;151:161-169. (C) 2011 by Elsevier Inc. All rights reserved.)