Clinicopathological findings of retinal angiomatous proliferation |
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Authors: | Hiroyuki Shimada Akiyuki Kawamura Ryuzaburo Mori Mitsuko Yuzawa |
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Institution: | (1) Department of Ophthalmology, School of Medicine, Nihon University, 1-8-13 Surugadai, Kanda, Chiyodaku Tokyo, 101-8309, Japan;(2) Department of Ophthalmology, Surugadai Hospital of Nihon University, 1-8-13 Surugadai, Kanda, Chiyodaku Tokyo, 101-8309, Japan |
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Abstract: | Background Neovascular membranes obtained from surgical excision of neovascularization for retinal angiomatous proliferation (RAP) were
examined histopathologically in an attempt to elucidate the pathogenic mechanism of RAP.
Methods Nine eyes of eight patients (mean age, 79±6 years) who underwent neovascularization excision were studied. Three eyes had
stage II with RPE detachment, six had stage III. Immunohistochemical studies were performed to identify von Willebrand factor,
vascular endothelial factor (VEGF), CD68 and hypoxia inducible factors (HIF-1 alpha and HIF-2 alpha).
Results Multiple soft drusen were present in the macular area in all patients. In one stage II eye, we observed intraretinal neovascularization
as a VEGF-positive mass, CD68-positive macrophage migration and HIF expression. In another stage II eye, neovascularization
had extended above the RPE, while VEGF-positive fibroblasts were observed below the RPE. Therefore, in stage II, neither angiographic
nor histopathological examinations identified choroidal neovascularization. In one phase III eye, angiography demonstrated
choroidal neovascularization and chorioretinal anastomosis. Histopathologically, chorio-retinal communication was observed
in the region where the RPE was destroyed, and VEGF-positive neovascularization was also seen below the RPE.
Conclusions The findings of multiple drusen in elderly patients together with macrophage migration and HIF expression surrounding VEGF-positive
retinal neovascularization suggest ischemic and inflammatory factors to be associated with the development and progression
of RAP. |
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Keywords: | Retinal angiomatous proliferation Immunohistochemistry Vascular endothelial growth factor Hypoxia inducible factor Macrophage Intraretinal neovascularization Chorioretinal anastomosis |
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