Age-related macular disease in a 91-year-old patient: Histologic findings
ABSTRACT Age-related macular degeneration in the eye of a 91-year-old man was studied histologically. Typical of this disease, which
manifests as death of central photoreceptors, were dystrophic changes of the retinal pigment epithelium (RPE) and neural retina.
Also typical were increased drusen deposits, which accumulated between the RPE basement membrane and the inner layer of Bruch's
membrane, and choroidal neovascularization. We histologically observed and demonstrated a subclinical neovascularization that
fluorescein angiography did not.
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ABSTRACT: Clinical and pathological examination was performed on 378 eyes from 216 patients aged 43 to 97 years. This series represented eyes in which the fundi were normal or showed various manifestations of senile macular degeneration. The eyes were divided into six groups according to the histological appearance of a linear deposit at the base of the retinal pigment cells. Groups I and II were considered to represent normal ageing, Groups III and IV the progressive development of senile macular degeneration and Groups V and VI the end-results. Group I showed no basal linear deposit. Thickening and hyalinization of Bruch's membrane was noted as early as the fifth decade. Group II showed patchy development of the basal linear deposit in relation to thickened or basophilic segments of Bruch's membrane, or over intercapillary hyalinization extending to the level of the outer surface of the choriocapillaris. Almost all eyes in these two groups retained a normal fundus appearance but visual acuity declined with age even in the absence of other causes. In Group III the basal deposit formed a thin continuous layer associated with moderate degeneration of the retinal pigment epithelium. More than half the eyes had developed a clinical disturbance of pigmentation and in most vision was reduced. Group IV was characterized by thickening of the deposit and more pronounced disturbance of the pigment epithelium. Clinically most eyes showed coarse pigmentary changes and vision was in the order of 6/24. 14-3 per cent of eyes in this group showed early neovascularization from the choroid. In Group V the pigment epithelium disappeared to produce circumscribed areas of depigmentation. The basal linear deposit could be traced throughout the depigmented area in most eyes. Thin fibrovascular sheets were found beneath the pigment epithelium in 41-7 per cent of eyes. Group VI represented disciform degeneration. The basal linear deposit could often be demonstrated as a disrupted hyalinized layer incorporated into the scar. Disciform degeneration was an alternative end-result to geographical atrophy. In each group the clinical and histological findings may be modified by the presence of drusen or by atrophy of the choroid. The basal linear deposit consisted of banded fibres embedded in granular material lying between the plasma infoldings and the basement membrane of the retinal pigment epithelium. This deposit seems to be a manifestation of gradual failure of the pigment epithelium and proved to be the most suitable criterion by which to study the natural history of senile macular degeneration.British Journal of Ophthalmology 06/1976; 60(5):324-41. · 2.73 Impact Factor
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ABSTRACT: The late stages of age-related maculopathy (ARM), especially neovascular macular degeneration (ARMD), can severely affect central vision and are the main cause of blindness in the elderly in the Western world. It has been shown that angiogenic growth factors are present in neovascular membranes in ARMD. However, it is not known if angiogenic growth factors play a role in the onset of neovascularisation. In order to elucidate the involvement of angiogenic growth factors in the initiation of neovascularisation in early stages of ARM, the expression patterns of VEGF, TGF-beta, b-FGF, and PDGF-AA on 18 human maculae with ARM, and on 11 control specimens were investigated immunohistochemically. A significantly increased expression of VEGF (p = 0.00001) and TGF-beta (p = 0.019) was found in the retinal pigment epithelium (RPE) of maculae with ARM compared with control maculae. Furthermore, an increased expression of VEGF and PDGF was found in the outer nuclear layer of maculae with ARM. These results demonstrate an increased expression of VEGF in the RPE, and in the outer nuclear layer in maculae with ARM, that could be involved in the pathogenesis of neovascular macular degeneration. Furthermore, enhanced TGF-beta expression in the RPE cells of maculae with early stages of ARM was shown.British Journal of Ophthalmology 03/1997; 81(2):154-62. · 2.73 Impact Factor
Article: Age-related macular degeneration.British journal of hospital medicine (London, England: 2005) 01/2006; 66(12):677-81. · 0.25 Impact Factor