Next, to analyze the retinal vascular development, function and pathology in larval and adult mutant fish or controls, we injected fish at 5, 90, or 180 dpf with fluorescently labeled 70 kDa Dextran, a method commonly used to analyze vascular perfusion, permeability, and leakage, and investigated the retinal vasculature by confocal microscopy. At 5 dpf, we found a significantly reduced number of hyaloid vessels formed in all three homozygous mutant strains, as well as in heterozygous missense (
znf408rmc105/+) mutants (
Fig. 4), leading to significantly reduced hyaloid vascular density (
Supplemental Fig. S5). Ongoing hyaloid angiogenesis at these developmental stages was apparent by the presence of several vascular sprouts in all groups, but there were no significant differences in sprouting across the genotypes analyzed (
Supplemental Fig. S6). The hyaloid vessels that did develop, however, were well perfused and did not leak fluorescently labeled dextran from the plasma into the tissue (
Fig. 4a and
Supplemental Figure S6). In contrast to this early phenotype, homozygous mutant fish at 90 dpf developed robust retinal neovascularization as evidenced by widespread ectopic sprouting of retinal capillaries (
Figs. 4a and c and
Supplemental Figure S6). These new sprouts were thin and nonfunctional and as such did not support perfusion (
Fig. 4a) and did not significantly increase the density of the retinal vasculature, except for the
znf408rmc103/rmc103 strain (
Supplemental Fig. S5). Importantly, the vessels were also not leaky at this time point, as no fluorescently labeled dextran was found outside the vascular lumen (
Fig. 3a and
Supplemental Fig. S6). Interestingly, at later stages of disease development represented by 180 dpf fish, the unstable and nonperfused sprouts seen in the 90 dpf fish had largely regressed (
Fig. 4a), although a smaller yet statistically significant number of ectopic sprouts still remained (
Supplemental Fig. S6). The retinal vascular density had, however, returned to wild-type levels in the
znf408rmc103/rmc103 strain (
Supplemental Fig. S5). Interestingly, at this stage, the retinal vasculature had become extremely leaky, as demonstrated by multiple, large edematous pools of fluorescently labeled dextran that had accumulated under the inner limiting membrane of the retina, especially in the
znf408rmc103/rmc103 and
znf408rmc104/rmc104 strains (
Figs. 4a and d and
Supplemental Fig. S6). Collectively, these findings demonstrate a progressive retinal vascular pathology developing in
znf408-mutant zebrafish characterized by initially impaired hyaloid vessel development, followed by exaggerated retinal sprouting and that culminates in robust leakage and retinal edema. Importantly, this trajectory closely recapitulates the vascular changes found in patients with FEVR.