Confocal scanning laser microscopic findings of excised choroidal neovascular membranes of age-related macular degeneration and their comparison with the clinical features.

PURPOSE To evaluate the histopathological characteristics of choroidal neovascular membranes excised from eyes of patients with age-related macular degeneration (AMD) and to correlate their characteristics with the clinical features of AMD. METHODS Choroidal neovascular tissues were excised from 3 patients with AMD and examined by light and confocal scanning laser microscopy. The clinical features were obtained by fundus photography, fluorescein angiography (FA), and indocyanine green angiography (IA) and compared with the histopathological findings. RESULTS Light microscopy showed the presence around the vascular structures of cells containing pigment. Confocal scanning laser microscopy revealed lipofuscin signals of the retinal pigment epithelium cells around the vascular tissue that was also confirmed by three-dimensional reconstructed views from serial optical sections. Clinical observations of the fundus by IA showed that all 3 cases had areas with hyperfluorescence in early phase on IA. A dark rim was observed around the area of hyperfluorescence in 2 cases, and the dark rim was located within the neovascular membrane. The patterns of fluorescence were heterogeneous in some phases on IA, which reflected the histological heterogeneity of the neovascular membrane. CONCLUSIONS The retinal pigment epithelium cells appear to play a special role in the induction and regression of the choroidal neovascular membrane associated with age-related macular degeneration.