[Surgical Extraction of Subretinal Pseudotumors in Age Related Macular Degeneration. Clinical, Morphologic and Immunohistochemical Results]

We extracted massive disciform subretinal lesions in eight eyes of seven patients with age-related macular degeneration via pars plana access. The lesions were 4-12 mm. All eyes had additional pathological findings such as PVR detachments, vitreous hemorrhage or acute submacular hemorrhage, sometimes in combination with each other. In seven eyes the preoperative visual function was no better than perception of hand movements, in 1 eye 1/35. The postoperative visual acuity was in 1 eye 0.3, in 6 eyes between 1/50 and 1/10 and without improvement in 1 eye. An intraocular silicone oil tamponade (highly purified, 5000 cs) was used in all cases. In two eyes the postoperative complication was central submacular fibrosis, and in two eyes with large retinotomies over more than two quadrants there were PVR reactions that needed reoperation in one eye. One patient was operated on bilaterally with final visual acuities of 1/35 and 1/10. The morphological structure of the extracted disciform lesions was characterized by a central fibrotic zone surrounded by attached hematomas, which were organized from the central tissue. In the central parts histology showed single layers of pigmented cells arranged along a basal membranelike PAS-positive band. Cell differentiation revealed macrophages, fibroblasts, myofibroblasts, T-lymphocytes, and vascular cells with immunohistochemical positive stainings for CD 68, cytokeratin, vimentin, alpha-actin, UCHL-1, and factor VIII. The lesions were supplied by a main choroidal vessel with branches into the periphery of the tissue. This feeder vessel can cause severe intraocular hemorrhage when it ruptures during surgical tissue extraction. Further immunohistochemistry showed the presence of cell adhesion molecules such as fibronectin, VLA-2, VLA-5, and VLA-6, the vitronectin receptor, 1CAM-1, LFA-1, and the PDGF receptor B. Their presence reflects mechanisms of growth regulation. The surgical extraction of massive submacular disciform lesions is part of the treatment of selected cases of end stages in age-related macular degeneration.