Choriocapillaris Degeneration in Geographic Atrophy

Am J Pathol. 2019 Jul;189(7):1473-1480. doi: 10.1016/j.ajpath.2019.04.005. Epub 2019 Apr 30.

Abstract

Early age-related macular degeneration (AMD) is characterized by degeneration of the choriocapillaris, the vascular supply of retinal photoreceptor cells. We assessed vascular loss during disease progression in the choriocapillaris and larger vessels in the deeper choroid. Human donor maculae from controls (n = 99), early AMD (n = 35), or clinically diagnosed with geographic atrophy (GA; n = 9, collected from outside the zone of retinal pigment epithelium degeneration) were evaluated using Ulex europaeus agglutinin-I labeling to discriminate between vessels with intact endothelial cells and ghost vessels. Morphometric analyses of choriocapillaris density (cross-sectional area of capillary lumens divided by length) and of vascular lumen/stroma ratio in the outer choroid were performed. Choriocapillaris loss was observed in early AMD (Bonferroni-corrected P = 0.024) with greater loss in GA (Bonferroni-corrected P < 10-9), even in areas of intact retinal pigment epithelium. In contrast, changes in lumen/stroma ratio in the outer choroid were not found to differ between controls and AMD or GA eyes (P > 0.05), suggesting choriocapillaris changes are more prevalent in AMD than those in the outer choroid. In addition, vascular endothelial growth factor-A levels were negatively correlated with choriocapillaris vascular density. These findings support the concept that choroidal vascular degeneration, predominantly in the microvasculature, contributes to dry AMD progression. Addressing capillary loss in AMD remains an important translational target.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Choroid* / blood supply
  • Choroid* / metabolism
  • Choroid* / pathology
  • Female
  • Geographic Atrophy* / metabolism
  • Geographic Atrophy* / pathology
  • Humans
  • Male
  • Retinal Pigment Epithelium* / blood supply
  • Retinal Pigment Epithelium* / metabolism
  • Retinal Pigment Epithelium* / pathology
  • Vascular Endothelial Growth Factor A / metabolism*

Substances

  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A