Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch’s membrane opening minimum rim width optical coherence tomography measurements

Purpose: To compare glaucomatous from non?glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch’s membrane opening minimum rim width (BMO?MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods: This study was conducted in 40 eyes, comprising 20 eyes with non?glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO?MRW. Results: The 5?fold cross?validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86–1.00) using BMO?MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion: Hence, OCT?based BMO?MRW values could be used as an additional test to compare glaucomatous with non?glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.

Angioid streaks and optic disc drusen in cherubism: a case report / Estrias angióides e drusas de disco óptico no Querubismo: um relato de caso

ABSTRACT A 65-year-old female patient was referred to our hospital for evaluation for cataract surgery. Her past medical history included corrective jaw surgeries for facial deformities that developed during infancy and persisted through early adulthood. A complete ophthalmological examination revealed bilateral angioid streaks, drusen in both optic disc areas, and a subretinal neovascular membrane in the left macula. Genetic analysis revealed a mutation in the SH3BP2 gene compatible with the diagnosis of cherubism. Clinical and laboratory evaluation revealed no additional systemic disorders. Cherubism is a rare disease characterized by the development of painless fibro-osseous lesions in the jaws and the maxilla in early childhood. Ophthalmologic findings in this disease are primarily related to orbital bone involvement. This is the first report of AS and optic disc drusen in a patient diagnosed with cherubism. Our findings suggest that angioid streaks and optic disk drusen should be included in the differential diagnosis of ophthalmic disorders identified in patients with this genetic abnormality.

RESUMO Paciente de 65 anos, sexo feminino, foi encaminhada para avaliação de cirurgia de catarata. Relatou história de cirurgias mandibulares para correção de deformação facial desenvolvida ao longo da infância e adolescência. O exame oftalmológico completo mostrou estrias angióides bilaterais, drusas em ambas as áreas dos discos ópticos e membrana neovascular sub-retiniana na mácula esquerda. A análise genética revelou mutação no gene SH3BP2 compatível com o diagnóstico de Querubismo. A avaliação clínica e laboratorial descartou outros distúrbios sistêmicos. O Querubismo é uma doença óssea rara caracterizada pelo desenvolvimento de lesões fibro-ósseas indolores na mandíbula e maxila durante a primeira infância. Os achados oftalmológicos nesta doença estão principalmente relacionados ao envolvimento ósseo orbitário. Este artigo descreve pela primeira vez a ocorrência de estrias angióides e drusas de disco óptico no Querubismo. Enfatizamos que essa condição deve ser incluída no diferencial de pacientes com tais achados, principalmente quando ambos existirem em associação.

Morphological assessment of lamina cribrosa in idiopathic intracranial hypertension

Purpose: Technological development of optic coherence tomography has enabled a detailed assessment of the optic nerve and deeper structures and in vivo measurements. The aim of this study was to compare the lamina cribrosa morphology of the optic nerve in idiopathic intracranial hypertension (IIH) and healthy individuals. Methods: The lamina cribrosa morphology of optic nerve in 15 eyes with IIH and 17 eyes of healthy individuals were compared. Four parameters such as Bruch membrane opening (BMO), lamina cribrosa thickness (LCT), prelaminar tissue thickness (PTT), and anterior lamina cribrosa surface depth (ALCSD) were retrospectively evaluated. Results: By enhanced depth imaging-optic coherence tomography (EDI-OCT), PTT and BMO were found to be significantly greater (574,35 � 169,20 ?m and 1787,40 � 140,87 ?m, respectively) in IIH patients than healthy individuals (187,18 � 132,15 ?m and 1632,65 � 162,58 ?m, respectively), whereas ALSCD was found to be significantly less in IIH patients (234,49 � 49,31 ?m) than healthy individuals (425,65 � 65,23 ?m). There was not a statistically significant difference regarding LCT between the IIH patients (238,59 � 17,31 ?m) and healthy individuals (244,96 � 15,32 ?m). Conclusion: Increased intracranial pressure causes morphological changes in lamina cribrosa. Assessment of lamina cribrosa with EDI-OCT is important for diagnosis and follow-up of patients with IIH. EDI-OCT is objective, reproducible, and cost-effective assistive imaging tool in IIH patients.

In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration

A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as 揳typical� osteoma caused by failure to identify their extrachoroidal location.

The Shortest Radius of Curvature of Bruch's Membrane in Macular Optical Coherence Tomography

PURPOSE: To develop software to measure the shortest radius in curvature of Bruch's membrane from optical coherence tomography (OCT), and then to apply it to various types of eyes. METHODS: Macular OCT images consisting of 12 images of 9 mm radial scans were studied. The horizontal to vertical pixel ratios were changed to 1:1, and Bruch's membrane was marked automatically on each image. Software to measure the radius of Bruch's membrane curvature was developed. The shortest radius on each image was defined as r (mm) and the average r of 12 images was defined as R (mm). The reciprocal of R was multiplied by the constant, 337.5, which was defined as the posterior staphyloma (PS) index. RESULTS: The OCT images of five eyes were analyzed by the software, which could calculate the curvature of Bruch's membrane automatically. The PS indices were 12.7, 23.7, and 66.4 in eyes without refractive error (Case I), in the high myopic group without posterior staphyloma (Case II), and in the high myopic group with posterior staphyloma (Case V), respectively. The PS index gradually increased according to aging in a 37-year-old patient (Case IV) with mild staphyloma from 34.6 to 39.5 over 4 years. CONCLUSIONS: PS index is a novel parameter to reflect the level of posterior staphyloma, but further studies are needed to apply it to clinical patients.

Diagnostic Accuracies of Bruch Membrane Opening-minimum Rim Width and Retinal Nerve Fiber Layer Thickness in Glaucoma

PURPOSE: To compare the diagnostic capability of Bruch membrane opening-minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness for the detection of primary open angle glaucoma. METHODS: Spectral-domain optical coherence tomography (SD-OCT) with 24 radial and 1 peripapillary B-scans centered on the Bruch membrane opening (BMO) was performed. Two SD-OCT parameters were computed globally and sectorally: (1) BMO-MRW, the minimum distance between BMO and internal limiting membrane; and (2) peripapillary retinal nerve fiber layer (RNFL) thickness. The diagnostic performance of BMO-MRW and RNFL thickness were compared with receiver operating characteristic (ROC) analysis globally and sectorally. Areas under the ROC (AUC) were calculated and compared. RESULTS: One hundred fourteen eyes (52 healthy, 62 glaucomatous) of 114 participants were included. In global analyses, the performance of BMO-MRW was similar to that of RNFL thickness (AUC 0.95 [95% confidence interval {CI}, 0.91-0.99], and 0.95 [95% CI, 0.91-0.99], respectively, p=0.93). In sectoral analyses, the pair-wise comparison among the ROC curves showed no statistical difference for all sectors except for the superotemporal, superonasal, and nasal sectors, which had significantly larger AUCs in BMO-MRW compared to RNFL thickness (p=0.03, p<0.001, and p=0.03, respectively). The parameter with the largest AUC was the inferotemporal sector for both BMO-MRW and RNFL thickness (AUC 0.98 [95% CI, 0.96-1.00], and 0.98 [95% CI, 0.96-1.00], respectively, p=0.99). CONCLUSIONS: Global BMO-MRW performed as well as global RNFL thickness for detection of glaucoma. In superotemporal, superonasal and nasal sectors, regional BMO-MRW performed better than regional RNFL thickness.

Recent advances in histological changes of high myopia / 天津医药

The incidence of high myopia has increased yearly, which has been an area of focus for investigation. The complications of high myopia are contributing factors to blindness,such as posterior staphyloma, chorio-retinal atrophy, choroidal neovascularization, optic nerve head and macular defects. The study of histological changes helps clarify the mechanism. With the development of modern technology such as spectral-domain optical coherence tomography and enhanced depth imaging-technique, histological changes in high myopia can be measured accurately. The purpose of this review is to provide an update on various pathologic changes, including in sclera, Choroid/Bruch's membrane, optic nerve, vitreous and retina.

Analysis of Peripapillary Atrophy According to the Optic Disc Shape Using Spectral Domain OCT

PURPOSE: To analyze the structural changes in the beta-zone of peripapillary atrophy (PPA-beta) using cross-sectional image of the optic disc head from spectral-domain optical coherence tomography (SD-OCT) according to the optic disc shape. METHODS: One hundred thirty-seven eyes in 137 patients with glaucoma having PPA-beta and 31 normal eyes (control group) were evaluated retrospectively. Cross-sectional images of the optic disc were taken using the Cirrus HD-OCT. We classified optic disc patterns into normal, focal, myopic, generalized enlargement and senile sclerotic appearance types and analyzed the shape of Bruch's membrane (BM), composition of retinal layer and retinal slope according to the optic disc shape. RESULTS: Among the 137 eyes with glaucoma, 54 eyes were focal disc type, 34 eyes were myopic disc type, 28 eyes were generalized enlargement disc type and 21 eyes were senile sclerotic disc type. The myopic disc group showed a noticeable difference compared to the other groups in terms of a higher percentage of BM defect type, the lowest retinal slope (70.6 +/- 12.0degrees) and the earlier termination of retinal layers. The generalized enlargement disc group showed the highest percentage of curved BM type. Retinal slope angle increased with age and decreased with axial length. CONCLUSIONS: In the beta-zone of peripapillary atrophy, there were several differences in the shape of Bruch's membrane, composition of retinal layers and the retinal slope according to the optic disc shape.

Effects of tonifying spleen and promoting blood circulation on the retina and Bruch membrane in apolipoprotein E-deficient mouse with dyslipidemia / 中华实验眼科杂志

Background Dyslipidemia is one of the major causes of age-related macular degeneration (AMD).At present,the study of the preventive and treating methods of A MD is still a hot spot.Objective The purpose of this study was to observe the effect of tonifying the spleen and promoting blood circulation on the retina and Bruch membrane in apolipoprotein E-deficient (ApoE-/-) mice with dyslipidemia.Methods Thirty-six ApoE-/-mice aged 2 months were randomly divided into the normal diet group,high fat diet group and medicine group.A diet with a higher content of fat was given for 5 consecutive months to the mice of the high fat diet group and medicine group,and in the last month,a concoction that tonifies the spleen and promotes blood circulation was gavagely administered in the medicine group,and an equivalent volumes of normal saline solution was administered in the same way in the normal diet group and high fat diet group.Total plasma cholesterol (TC),low density lipoprotein (LDL)and triglyceride (TG) were detected by (ELISA? Name of assay?) using the 7170 Hitachi automatic biochemical analyzer,and morphological changes of the retina and Bruch membrane were examined by light microscopy and transmission electron microscopy.The number of outer nuclear layer (ONL) cells,retinal pigment epithelial (RPE) cells and the thickness of the Bruch membrane were examined by semi-quantitative histopathology with the Mias 2000 Imaging Analyzer System.Results The concentrations of TC,LDL and TG were (6.47 ±0.49) mmol/L,(1.46 ±0.10)mmol/L and (0.62 ±0.21) mmol/L,respectively,in 7-month-old mice of the medicine group,showing a significant reduction in comparison with (10.53 ±0.30) mmol/L,(1.90±0.13) mmol/L,(1.15±0.29) mmol/L of the high fat diet group,and (9.63 ± 0.18) mmol/L,(1.12 ± 0.15) mmol/L,(0.88 ± 0.21) mmol/L in the normal diet group (P＜0.05-0.01).The disorder and atrophy of ONL and RPE cells,divergence of fiber of the Bruch membranes were found in both the high fat diet group and normal diet control group under the light microscope,and drusen formed in some of the mice in the high fat diet group.However,ONL and RPE were well organized in the medicine group.The cell numbers in the ONL and RPE layer in the 7-month-old mice were (23 124.00±755.18) and (10.75±0.59),respectively,in the medicine group,(19 107.00 ± 1436.82) and (8.55 ± 1.11),respectively,in the high fat diet group,(21 663.00± 1073.27) and (9.75 ±0.58),respectively,in the normal diet group,with significant differences among them (P＜0.05-0.001).Thickness of the Bruch membrane in the medicine group extensively reduced in high fat diet group and normal diet control group (P＜0.01).The ultrastructures of the RPE and Bruch membrane were much more improved in the mdedicine group.Conclusions Tonifying the spleen and promoting blood circulation can attenuate hyperlipemia in ApoE-/-mouse;furthermore,it lessens the pathological abnormalities in the ONL,RPE and Bruch membrane.

Expression and location of ARMS2 protein in normal eye tissue / 中华实验眼科杂志

Background Researches determined that the alteration of A69S locus of age-related maculopathy susceptibility 2 ( ARMS2 ) gene is closely associated with the pathogenesis and progression of age-related maculopathy ( AM D ).However,the location of ARMS2 protein in normal eye tissue is still in controversy,therefore,its function is below understanding up to now.Objective The goal of this laboratory work was to investigate the distribution,expression and location of ARMS2 protein in normal adult retina and choroid as well as in retinal pigment epithelial (RPE) cells and lay a basis for exploring further its function in the protein level.Methods Ten donor eyeballs of normal adult male with the age from 28-42 years were collected in eye bank of Qingdao Eye Hospital.The frozen sections of the retina and choroid were prepared for the detection and location of ARMS2 in 3 eyes by immunofluorescence under the confocal laser microscope.The retina was isolated for the primary culture of RPE cells using explant culture method.The cells were then identified by CK32 antibody by immunofluorescence.The distribution and expression of the ARMS2 protein in retina,ehoroid and RPE cells were determined by immunofluorescence technique.Results ARMS2 protein was strongly expressed in retinal vessel,RPE cell layer,Bruch membrane and choroidal vessel,but weak expression was in retinal ganglion cell layer,inner nuclear layer,outer plexiform layer,outer nuclear layer and inner plexiform layer in the normal eyes.The primarily cultured cells appeared the polygon shape with the abundant pigment in cytoplasm.The immunofluorescence of the cells showed the positive response for CK32,exhibiting the green fluorescence granules in the cytoplasm.The positive expression of ARMS2 protein also was seen in the cytoplasm of RPE cells,appearing the red fluorescence.Conclusions ARMS2 protein mainly distribute and locate retinal and choroidal vessels,RPE cells and Bruch membrane in normal eye.

Characterization of Peripapillary Atrophy Using Spectral Domain Optical Coherence Tomography

PURPOSE: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). METHODS: SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral beta-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized. RESULTS: Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes. CONCLUSIONS: The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.

Alterações vasculares na coróide de ratos diabéticos tratados e não tratados / Choroidal vessels alterations in treated and untreated diabetic rats

OBJETIVO: Conhecer os efeitos do diabetes e o impacto de seu tratamento medicamentoso em curto e longo prazo sobre os vasos da coróide e membrana de Bruch. MÉTODOS: Foram estudados 30 ratos Wistar, divididos em 3 grupos experimentais: grupo controle (GC), grupo diabético (GD) e grupo diabético tratado (GT), estudados 1 mês (momento M1) e 12 meses (momento M2) após o início do experimento. O diabetes foi induzido por aloxana endovenosa, na dose de 42 mg/kg. O GT foi tratado com hipoglicemiante oral (acarbose) e insulina subcutânea. Após o sacrifício, os olhos foram preparados para exame ao microscópio eletrônico de transmissão, interessando a ultra-estrutura da membrana de Bruch e os vasos da coróide. RESULTADOS: O exame ultra-estrutural da coróide dos ratos diabéticos mostrou depósitos na membrana de Bruch, acúmulo de vesículas, glicogênio e corpos densos no citoplasma das células endoteliais. O grupo mais afetado foi de ratos diabéticos de 12 meses (GDM2). Os animais com menor intensidade de alterações foram os ratos tratados por 12 meses (GTM2). CONCLUSÃO: Os ratos diabéticos desenvolveram alterações degenerativas na membrana de Bruch e vasos da coróide. Estas alterações foram mais evidentes nos animais submetidos à doença crônica, mas também ocorreram agudamente. O tratamento a curto prazo não foi capaz de evitar os processos degenerativos. A longo prazo, o tratamento inibiu a progressão destes processos.

PURPOSE: To evaluate the diabetic alterations and the impact of short and long-term medical treatment on them. METHODS: Thirty Wistar rats were divided into 3 groups: control (GC), diabetic (DG), and treated diabetic (TG) and the observations were made 1 month (M1) and 12 months (M2) after diabetes induction. Diabetes was induced by intravenous alloxan (42 mg/kg). The treated group received acarbose orally and insulin by subcutaneous injection. Eyes were prepared for transmission electron microscopy, specifically for ultrastructure of the Bruch membrane and choroidal vessels. RESULTS: Ultrastructural examination of the diabetic rat coroid showed deposits in the Bruch membrane and accumulation of vesicles, glycogen and dense bodies in endothelial cell cytoplasm. The most affected group was that of the diabetics on month 12 (GDM2). The treated diabetics showed the least alterations on month 12 (GTM2). CONCLUSION: Diabetic rats develop degenerative alterations in the Bruch membrane and choroidal vessels. These alterations are more evident in animals submitted to chronic disease, but they are also present in acute disease. Degenerative processes were not avoided with short-term treatment. Long-term treatment inhibited the progress of these processes.

Tyrosine nitration site specificity identified by LC/MS in nitrite-modified collagen type IV

Non-enzymatic nitrite induced collagen cross-linking results in changes reminiscent of age-related damage and parallels the well-known model system, non-enzymatic glycation. We have recently observed that nitrite modification of basement membrane proteins can induce deleterious effects on overlying retinal pigment epithelial cells in studies relevant to age-related macular degeneration. The present work was undertaken in order to confirm 3-nitro-tyrosine (3-NT) as a product of the reaction and to identify the site specificity of nitration in collagen IV, a major component of basement membranes. Human collagen type IV was modified via incubation with 200 mM NaNO2 (pH=7.38) for one week at 37degrees C. The modified protein was prepared in 2 different ways, including acid hydrolysis and trypsin digestion for site specificity determination. The samples were analyzed by LC/MS using a C12 RP column. Site specificity was determined from tandem MS/MS data utilizing TurboSEQUEST software and the Swiss-Prot sequence database. 3-NT was detected in protein digests and acid hydrolysates of nitrite modified collagen IV. Positive identification with standard 3-NT was confirmed by identical Rt, lambda(max)=279 nm and 355 nm, and m/z=227. Analyses of tryptic digests identified four sites of tyrosine nitration, alpha1(IV)Y348, alpha1(IV)Y534, alpha2(IV)Y327, and alpha2(IV)Y1081. These sites are located in the triple-helical region of the protein and provide clues regarding potential sites for nitrite modification in collagen type IV.

Effects of Exogenous Extracellular Matrix Proteins on the Reattachment of Retinal Pigment Epithelial Cells

PURPOSE: To evaluate the effect of adding exogenous extracellular matrix (ECM) proteins on the reattachment of retinal pigment epithelium (RPE) to the damaged surface of Bruch's membrane (BM). METHODS: Porcine BM explants were divided into six groups: BMs with an intact basal lamina (bl-BM) and five damaged BMs (d-BM: bare & four ECM-coated). The d-BM was coated with ECM proteins (either fibronectin, laminin, collagen IV, or all). Primary RPE sheets were plated and cultured for each group of BM explants. The attached live cells were counted and examined with a scanning electron microscope after three days, as well as at 1, 2 and 4 weeks. RESULTS: The RPE reattachment rate was highest in bl-BM and lowest in uncoated d-BM. ECM-coated groups showed a lower reattachment rate than bl-BM, but when compared with the uncoated group, the reattachment rate was significantly increased (p<0.05). ECM-exposure time did not influence the reattachment rate of any of the groups. RPE cells plated on bl-BMs and ECM-coated d-BMs attached and proliferated well and achieved confluence over time. Even though most cells were flat and large in shape, some cells revealed a good morphology with microvilli on their surface. On the other hand, only some of the RPE sheets plated on the uncoated d-BM attached loosely and most cells remained round and clumped. CONCLUSIONS: These results show that the addition of ECM proteins may increase the ability of RPE cells to reattach to the damaged BM surface, which would likely create a good morphology.

Cultured Morphology by Tissue types of Retinal Pigment Epithelial Cells Transplanted onto the Bruch's Membrane

PURPOSE: To compare the cultured morphology of retinal pigment epithelium (RPE) cells which were transplanted onto the Bruch's membrane (BM) in different tissue types. METHODS: Cultured porcine RPE cells were harvested in three types of transplants: single cell (SC) suspension, cell cluster (CC) suspension and cell sheet (CS). After RPE cell transplants were plated onto the porcine BM explants at three different cell concentrations, they were dissected and examined with a transmission electron microscope and a scanning electron microscope at 1 day, 3 days, and 1, 2 and 4 weeks for morphological study. RESULTS: All types of RPE transplants were grown and proliferated well on BM and required a shorter time to reach confluence with higher cell concentration. Although CC transplants took a little longer to reach confluence on BM than SC transplants, they were nevertheless well grown on BM and showed good cellular morphology in monolayer. The time to confluence was much longer for the CS transplants than for the SC and CC transplants and the proliferated cells tended to be large, flat and to have scanty microvilli on the cell surface with reaching peripheral portion of confluent cell layers. CONCLUSIONS: CC suspension may be a better candidate for RPE transplantation in the case of using cultured RPE cells as transplant.

The Role of VEGF and Bruch's Membrane in the Development Choroidal Neovascularization

A major cause of blindness in elderly people is choroidal neovascularizapathogenesis and stimulating factor of CNV is not clearly understood. Vascular endothelial growth factor(VEGF)is a major stimulating factor for retinal neovascularization in ischemic retinopathy such as diabetic retinopathy, retinopathy of prematurity. But it is not known if VEGF is a stimulating factor for CNV. In this study, we have treated VEGF transgenic mice and C57BL/6 mice with laser. Different laser parameter for damage to retina pigment epithelium(RPE)only and for break of Bruch's membrane were used each. We were not able to induce CNV with only RPE damage. CNV wes induced when the break of Bruch's membrane was made and there was profuse CNV in VEGF transgenic mice rather than C57BL/6. These data suggest that the damage of Bruch's membrane may be the prerequisition for CNV formation and VEGF is the important stimulating factor for CNV.

A morphometric analysis of age-related changes in the RPE, Bruch's membrane and choroid of human eyes / 中华眼底病杂志

Purpose To identify and quantitatively evaluate age related changes in the retinal pigment epithelium (RPE) and underlying Bruchs membrane and choroid in donor human eyes. Methods 36unpaired human eyes of varying age (3～93 years) from Caucasian donors were supplied by Manchester Eye Bank (UK) or National Disease Research Interchange (Philadephia,USA).Modified Massons trichrome staining was used to illustrate age related changes in RPE cell, Bruchs membrane thickness, and density of choriocapillaries and thickness of the choroid. Data were assessed using computer aided quantitative morphometric analysis method. Results The thickness of Bruchs membrane increased with age while there is a change in morphology of RPE cells including a decrease in number and RPE cell thickening with age. RPE cells decreased at a rate of 8 cells/mm 2?year, RPE cell height and thickness of Bruchs membrane increased at rates of 0.01(?m/year) and 0.02 (?m/year) respectively. The luminal area of choriocapillaries and the thickness of choroid showed no close relation with age. Conclusion RPE cell loss and thickening of Bruchs membrane and RPE cells may be the earlier and primary alteration with age.

Retinal Pigment Epithelial Detachment in Posterior Scleritis

Posterior scleritis must be one of the most underdiagnosed treatable conditions in ophthalmology, partly because its manifestations are so protean and partly because the diagnosis is rarely considered. Although ultrasonography and computer tomogram are ancilliary tests, a careful examination of the posterior segment of the eye including the area of the ora serrata, macula and disc is essential to discover the presence of a posterior scleritis. We experienced prolonged retinal pigment epithelial detachments which had appered at early phase of posterior scleritis.