RESUMO
PURPOSE: To analyze and compare the histopathology of surgically extracted membranes in hemorrhagic age-related macular degeneration (AMD) versus extracted classic, mixed and occult choroidal neovascularization (CNV) in AMD. METHODS: Thirty consecutive membranes, surgically removed in hemorrhagic AMD, were analyzed and compared with consecutive series of 50 classic, 20 mixed and 20 occult membrane specimens in exudative AMD. The specimens were serially sectioned and stained in a stepped fashion with hematoxylin-eosin, Masson trichrome and periodic acid-Schiff stain. RESULTS: Diffuse drusen were observed in all hemorrhagic AMD specimens, fibrovascular tissue was found in 29 of 30 specimens which was located subretinally in 11 specimens and/or in Bruch's membrane in 28 specimens. A hemorrhage was located subretinally in 21 specimens, in the stroma of the fibrovascular tissue in 17 specimens, at the choroidal side of the diffuse drusen adjacent to fibrovascular tissue in 13 specimens and at the choroidal side of the fibrovascular tissue in Bruch's membrane in 8 specimens. Grossly dilated thin-walled vessels were identified in one hemorrhagic AMD case, suggestive of polypoidal choroidal vasculopathy. Scarred tears of the retinal pigment epithelium were identified in two specimens. CONCLUSION: A large spectrum of histo-architectural lesions is recognized in hemorrhagic maculopathy. Hemorrhages do not only characteristically appear in the subretinal space or in the stroma of the neovascular tissue but also at the choroidal side of the diffuse drusen adjacent to the neovascular complex and at the choroidal side of the intra-Bruch's fibrovascular tissue.