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Clinicopathological correlation of an excised choroidal neovascular membrane in pseudotumour cerebri
A A Castellarin1, I K Sugino, M Nasir
1Department of Ophthalmology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103-2499, USA.
Aims/Background:
To correlate the histopathology of an excised choroidal neovascular membrane (CNV) with the clinical and angiographic findings in a 32-year-old woman with pseudotumour cerebri and a peripapillary CNV with subfoveal extension.
Methods:
The patient's visual acuity was assessed by individuals experienced in low vision refraction and who were not members of the surgical team. The CNV was excised via a conventional three port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FAs) and fundus photographs were obtained to study the dissection bed.
Results:
One week after surgery, the FA showed mottled subfoveal choriocapillaris perfusion. Three weeks after surgery, this area showed retinal pigment epithelium (RPE) atrophy clinically, and the FA showed choriocapillaris non-perfusion. Six months after surgery, the area of RPE atrophy and the corresponding area of choriocapillaris non-perfusion had expanded. Histologically, the excised CNV disclosed hyperplastic RPE, fibrovascular tissue, and no choriocapillaris. Fragments of RPE basement were present along the external edge of the specimen. The patient's visual acuity did not improve significantly after surgery.
Conclusions:
Choriocapillaris non-perfusion can develop even in young patients following CNV excision. In this particular case, it is believed that choriocapillaris atrophy was caused by incomplete ingrowth of RPE into the dissection bed following RPE removal with CNV excision. As far as is known, this is the first report describing the results of surgery for CNV secondary to papilloedema associated with pseudotumour cerebri.
Insights
Choroidal neovascularization (CNV) excision in a young patient with pseudotumor cerebri led to choriocapillaris non-perfusion and RPE atrophy. This suggests incomplete retinal pigment epithelium (RPE) regeneration post-surgery, impacting vision.
Area of Science:
- Ophthalmology
- Histopathology
- Vascular Biology
Background:
- Investigated a rare case of peripapillary choroidal neovascularization (CNV) with subfoveal extension in a 32-year-old woman diagnosed with pseudotumor cerebri.
- Correlated histopathological findings of excised CNV with clinical and angiographic data.
Observation:
- Surgical excision of CNV was performed using vitrectomy and subretinal dissection.
- Histological analysis of the excised CNV revealed hyperplastic retinal pigment epithelium (RPE), fibrovascular tissue, and absence of choriocapillaris.
- Postoperative fluorescein angiography showed progressive choriocapillaris non-perfusion and RPE atrophy in the affected area.
Findings:
- Excised CNV lacked choriocapillaris, suggesting its prior involvement or destruction.
- Post-surgical RPE atrophy and choriocapillaris non-perfusion expanded over six months.
- Histopathology confirmed RPE hyperplasia and fibrovascular tissue within the excised CNV specimen.
Implications:
- Choriocapillaris non-perfusion can occur post-CNV excision, even in young individuals.
- Incomplete RPE regeneration into the surgical bed may cause persistent visual deficits.
- This case highlights potential complications of CNV excision secondary to papilledema in pseudotumor cerebri.