CLINICOPATHOLOGICAL STUDIES OF AN EYE AFTER SUBMACULAR MEMBRANECTOMY FOR CHOROIDAL NEOVASCULARIZATION

Background: Submacular membranectomy has been suggested as an alternat ive treatment for subfoveal choroidal neovascularization (CNV). Clinic opathologic features of the right eye of a 59-year-old man with recurr ent subfoveal CNV who underwent submacular membranectomy after two uns uccessful laser photocoagulation treatments are reported. Methods: The surgically excised subfoveal membrane was sectioned serially and eval uated by light microscopy. The globes were obtained postmortem and ser ial sectioned through the macula and optic nerve head for light micros copy. Ultrastructural study of a tissue section in the center of the l esion was performed.Results: Histopathologic study of the surgically e xcised membrane disclosed a thin two-component fibrovascular membrane with the larger component internal to residual retinal pigment epithel ium and basal laminar deposit. Photoreceptor outer segments were prese nt on the internal surface of the membrane near one margin. Light and electron microscopic study of the postmortem globe revealed a very thi n subfoveal subretinal pigment epithelial fibrovascular membrane with loss of photoreceptor cell layer in a central 0.5 mm area, loss of out er segments, reduction of inner segments, and thinning of the outer nu clear layer in the remainder of the lesion. There was moderate retinal pigment epithelial attenuation and mild basal laminar and basal linea r deposits. Conclusion: Submacular membranectomy for recurrent subfove al CNV secondary to age-related macular degeneration after two unsucce ssful laser photocoagulation treatments appeared to be effective with repopulation of two thirds of the area of membranectomy by extension o f attenuated retinal pigment epithelium from adjacent areas. There was , however, persistence or recurrence of CNV, moderate atrophy of the o verlying retina with total loss of the photoreceptor cells over the ce ntral 0.5 mm of the membrane, and moderate loss of the photoreceptor c ells over the remaining area.