Clinicopathological correlation of choroidal neovascularization after external beam radiotherapy in age-related macular degeneration.

Abstract

PURPOSE:

To analyze the histopathology of choroidal neovascularization after external beam radiotherapy in age-related macular degeneration.

METHODS:

A retrospective non-case-matched comparative histopathologic study. The histoarchitecture of nine surgically removed subretinal specimens from nine patients that had undergone external beam radiotherapy for exudative age-related macular degeneration was studied. Seven patients had received 20 Gy in 10 fractions and two 15 Gy in 5 fractions with an average time interval between radiotherapy and surgical extraction of 14 months (range 3-28). A consecutive series of classic, mixed and occult choroidal neovascular membranes served as controls.

RESULTS:

Clinical findings. Radiation-associated choroidal neovasculopathy was angiographically suspected in four patients: a coarse net of vessels on fluorescein angiography developing at the border of previously irradiated choroidal neovascularization was observed in three patients; blebs at the margin of a plaque on indocyanine green angiography were observed in two patients. Pathological findings. Diffuse drusen as well as intra-Bruch's fibrovascular tissue was found in all irradiated specimens. In four specimens an edematous vascularized layer was seen between diffuse drusen and normal-appearing intra-Bruch's fibrovascular tissue. This lesion was not found in the control specimens. A particular correlation for the bleb lesion was not recognized.

CONCLUSION:

The appearance of an edematous subretinal pigment epithelial vascularized layer between diffuse drusen and normal-appearing fibrovascular tissue in four of nine irradiated membranes may be secondary to previous irradiation. It may correlate with the unusual exudative manifestations observed after external beam radiotherapy.

• Authors: S Aisenbrey, B A Lafaut, S Reynders, P Szurman, S Grisanti, C Vanden Broecke, P Walter, K U Bartz-Schmidt
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 241 Issue 4 Pg. 269-76 (Apr 2003) ISSN: 0721-832X [Print] Germany
• PMID: 12719987 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Bruch Membrane (pathology)
• Choroid (blood supply, radiation effects)
• Choroidal Neovascularization (diagnosis, etiology, pathology, surgery)
• Female
• Fluorescein Angiography
• Humans
• Macular Degeneration (complications, radiotherapy)
• Male
• Middle Aged
• Pigment Epithelium of Eye (pathology)
• Radiation Injuries (diagnosis, etiology, pathology, surgery)
• Radiotherapy (adverse effects)
• Retrospective Studies