Diabetic neovascularization: permeability and ultrastructure.

The permeability of newly formed blood vessels in proliferative diabetic retinopathy at different stages of development was correlated with their ultrastructural features. The young proliferating vessels were much more permeable to fluorescein than were the older vessels. Transmission electron microscopy revealed that the blood vessels within the young intravitreal proliferating fronds had intermediate interendothelial junctions, whereas the blood vessels within the old neovascular preretinal membranes had tight interendothelial junctions of the macula occludens type. Fenestrations were observed only rarely in the endothelial wall of either the young or the older proliferating vessels. We conclude that the principal route of fluorescein leakage from the newly formed blood vessels in proliferative diabetic retinopathy is via the interendothelial clefts.