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A Assadoullina, H Feichtinger, S Binder, I Krebs; Subfoveal Neovaskular Membranes - Membrane Histopathology and Patient Outcome After Combined Subretinal Surgery and Autologous RPE Transplantation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3455.
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Purpose: We have recently described a therapeutic modality of combined subretinal surgery and simultaneous autologous transplantation of RPE for the treatment of CNV in patients with AMD. The purpose of the present study was to determine whether the morphological type and composition of the membranes was correlated with patient outcome. Methods: 19 AMD patients underwent combined subretinal surgery and autologous transplantation of RPE. The membranes were prepared for conventional histology and evaluated for their morphological composition on serial sections applying a semiquantitative score of 0, 1+, 2+ and 3+ to the following parameters: amount of acellular matrix, neovascularization/microvascular density (MVD), cellularity with special reference to inflammatory cells, and RPE atrophy/hyperplasia. These data were correlated with preoperative FAG as well as postoperative visual acuity, biomicroscopy, FAG and ICG findings, and progression or development of recurrence. Results: All 19 membranes contained a significant amount of acellular matrix (scores 2+/3+); a prominent neovascularization/high MVD was present in 13/19 specimens and was strongly associated with a high degree of cellularity, i.e. corresponded with a moderate or marked inflammatory component/infiltrate predominated by limphocytes (14/19). 4/19 membranes had features of avascular scars. 4/19 membranes exhibited severe atrophy of RPE. By preoperative FLA all lesions but one were classified as clinically predominantly occult. RPE detachment or tears were seen in FLA of 5/19 patients, but did not correspond to a specific histopathologic pattern. When compared to the postsurgical/post-Tx development of visual acuity, FAG and ICG findings histopathological features were not predictive. Recurrences did not occur. Conclusion: In a pilot study of 19 patients with advanced AMD/CNV treated with combined subretinal surgery and autologous RPE transplantation features other than membrane morphology seem to determine patient outcome.
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