Clinicopathological correlation in exudative age-related macular degeneration: recurrent choroidal neovascularization

Purpose: To report the pathology of surgically removed submacular tissue in recurrent choroidal neovascularization after laser photocoagulation of cla ssic choroidal neovascularization in age-related macular degeneration. Meth ods: A recurrent subfoveal choroidal neovascular membrane was surgically re moved in two patients. The recurrence was identified as a classic membrane on fluorescein angiography at the foveal border of the laser scar. A net wa s visualized in the early venous phase of the indocyanine green angiogram, with associated late hyperfluorescence. Both patients had undergone laser p hotocoagulation for a classic interpapillomacular choroidal neovascular mem brane about 1 1/2 years earlier. The specimens were serially sectioned and stained with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome and phosphotungstic acid-hematoxylin. Results: The two specimens consisted of s ubretinal fibrovascular tissue with fibrin exudation. Fibrovascular tissue bordered subretinal fibrous tissue adherent to Bruch's membrane and remnant s of the choroid in one patient. The fibrovascular portion most likely corr esponded to the recurrence, whereas the fibrous portion represented the ori ginal membrane, being obliterated after photocoagulation. Some peripapillar y tissue was additionally removed in the other patient. The latter lesion w as invisible on fluorescein angiography but stained in the late phase of in docyanine green angiography and corresponded histopathologically to poorly vascularized intra-Bruch's fibrovascular tissue. Granular deposits, periodi c acid-Schiff positive and metachromatically purple on Masson trichrome sta in, representing diffuse drusen (basal laminar/linear deposits), were ident ified in the three specimens. Conclusion: A subretinal fibrovascular membra ne corresponded with the classic recurrent choroidal neovascularization.