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Chandra Balaratnasingam, Christine A Curcio, Jeffrey D Messinger, Jonathan Naysan, Kunal K Dansingani, Lawrence A. Yannuzzi, K Bailey Freund; Choroidal neovascularization during and following vitelliform collapse: a clinical and histopathological study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3533.
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To determine the rate of neovascularization (NV) in eyes with acquired vitelliform lesion (AVL) during and following vitelliform collapse. To correlate the optical coherence tomography (OCT) and histopathological characteristics of these neovascular membranes.
Retrospective cohort analysis of 112 patients with AVL. Patients that demonstrated evidence of vitelliform collapse, defined as a temporal reduction in the size of subretinal vitelliform material clinically, using OCT and fundus autofluorescence imaging, were included for further analysis. Clinical and OCT characteristics of neovascular membranes were determined. A correlation between OCT and histopathological characteristics of an eye that was clinically diagnosed as non-neovascular but demonstrated a type 1 membrane on post mortem examination was also performed.
Twenty-six patients (16 males and 10 females) demonstrated evidence of vitelliform collapse, and 7 (26.9%) of these developed NV. 5 of these patients were diagnosed with NV following acute subretinal hemorrhage or exudation. Mean age of patients was 81.1 ± 11.6 years, and mean period of follow up was 9.0 ± 4.2 years. All neovascular membranes were type 1. Persistent OCT findings prior to the development of NV included: (1) Irregular elevation of the retinal pigment epithelium (RPE) layer at the site of NV. (2) Separation of the RPE layer and Bruch’s membrane (BrM) by a hyporeflective material containing punctate hyper-reflectivity (figure 1). Three patients had fluorescein angiography (FA) within 6 months preceding the diagnosis of neovascular disease that did not demonstrate leakage. Histopathologic examination demonstrated a fibrovascular scar and thick basal laminar deposit (BlamD) under the fovea with hemorrhage between the scar and BrM. These lesions correlated with the split RPE-BrM band on OCT images acquired 8 months before the patient’s death (figure 2).
The rate of Type 1 NV during and following vitelliform collapse in AVLs is significant. In this subgroup of patients, neovascular membranes appear to remain dormant in the anatomic space between BrM and BLamD before the clinical signs of NV, including exudation and hemorrhage, become manifest. Interval review of these patients is therefore indicated as is a prospective study of this topic.
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