Dr. Freund reported that “the clinical imaging showed a deep neovascular lesion in close relationship with a mixed serous and drusenoid pigment epithelium detachment (PED) characteristic of type 3 NV. Antiangiogenic therapy achieved complete resolution of the exudation. The PED progressively flattened with each treatment, leaving a persistent triangular hyperreflectivity in the outer retina, which was correlated histologically with a vascular complex implanted into sub-RPE basal laminar deposit (BLamD). No connection between the choriocapillaris and the sub-RPE plus BLamD space was observed. Both the RPE-derived and lipid-filled cells were correlated with clinical intraretinal hyperreflective foci. The sub-RPE plus BLamD space contained macrophages, lymphocytes, Müller cell processes, and subducted RPE.”
The authors published their findings (Ophthalmology. 2018;125:276-287. doi: 10.1016/j.ophtha.2017.08.019. Epub 2017 Sep 28).
This case study showed the clinicopathologic correlation of type 3 NV with vascular elements of retinal origin accompanied by collagenous material and Müller cell processes implanted into the thick sub-RPE basal laminar deposit, which may simulate the appearance of chorioretinal anastomosis. Surrounding RPE-derived and lipid-filled cells, possibly microglia, were correlated with clinical intraretinal hyperreflective foci.
“In this patient with type 3 NV, there was no evidence of a choroidal origin of the lesion,” Dr. Freund concluded.