Original Articles
Clinicopathologic correlations of surgically excised type 1 and type 2 submacular choroidal neovascular membranes

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Abstract

Purpose: To correlate the histologic and clinical classification of type 1 (subretinal pigment epithelium) and type 2 (subsensory retina) choroidal neovascularization.

Methods: Ten eyes of 10 patients with surgically excised choroidal neovascularization that were routinely processed and could be histologically classified as having a type 1 or type 2 configuration were studied. The patients were clinically classified as having type 1 or type 2 choroidal neovascularization according to preoperative fundus appearance of both eyes and patient age. The histologic and clinical classifications were made in a masked fashion, and the results were compared.

Results: The histologic classification was type 1 and type 2 for three and seven specimens, respectively. The clinical classification matched the histologic classification in nine of 10 cases. Clinical fundus characteristics that distinguished type 2 choroidal neovascularization included a subretinal pigmented halo or pigmented plaque in the area of the choroidal neovascularization and sharply defined borders. Patients with type 1 membranes were on average older (76 years) than patients with type 2 membranes (53 years).

Conclusions: It is generally possible to clinically ascertain by clinical fundus appearance and age of a patient whether subfoveal choroidal neovascularization represents a type 1 or type 2 configuration.

Section snippets

Methods

The records of the L. F. Montgomery Ophthalmic Pathology Laboratory, Emory University, were searched for the year 1996 for surgically excised subfoveal choroidal neovascularization specimens. The technique for surgical removal has been previously described.21 The surgeons attempted to remove the choroidal neovascularization intact and lay the external side (choroid side) of the specimen down on a surgical sponge. The choroidal neovascularization specimens were fixed in 10% neutral buffered

Results

Thirty surgically excised choroidal neovascularization specimens from 30 eyes eligible for this study were accessioned in 1996. Of the 30 specimens, three were histologically classified as type 1, seven as type 2, and five as combined; 15 could not be histologically classified with regard to orientation due to artifactual folding and redundancy. Therefore, 10 eyes of 10 patients had subfoveal choroidal neovascularization (three, type 1; seven, type 2) eligible for the study. The results of

Discussion

The advent of submacular surgery has enabled clinicopathologic correlation, including fluorescein angiography, at relatively early stages in the evolution of choroidal neovascular membranes. Examination of the excised neovascular membranes from patients with different underlying diseases has been described.24., 25., 26., 27., 28., 29. The cellular and extracellular components of the membranes, including retinal pigment epithelium, vascular endothelium, fibrocytes, macrophages, photoreceptors,

Acknowledgements

The authors wish to thank Drs Thomas M. Aaberg, Sr, Robert Bergen, Logan Brooks, Antonio Capone, Jr, David d’Heurle, William Hagler, Michael Jacobson, Jerome Magolan, Daniel F. Martin, Philip Martin, David Saperstein, Paul Sternberg, Jr, and William Wood for submitting specimens, and Mr James Gilman for providing illustrations.

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    Supported in part by departmental core grant no. EY06030 from the National Institutes of Health, Bethesda, Maryland, and an unrestricted departmental grant from Research to Prevent Blindness, Inc, New York, New York.

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