Progressive Optic Disc Tilt in Young Myopic Glaucomatous Eyes

PURPOSE: To explore the progressive change and associated factors of optic disc tilt in young myopic glaucomatous eyes by analyzing long-term follow-up data.METHODS: Optic disc images were obtained from spectral-domain optical coherence tomography enhanced depth imaging from at least five different visits. At each visit, the disc tilt angle (DTA), defined as the angle between the Bruch's membrane opening plane and the optic canal plane, was estimated at the central frame that passes through the optic disc. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field (VF). A linear mixed effect model was used to assess the influence of parameters (age, sex, baseline and follow-up intraocular pressure, retinal nerve fiber layer thickness, VF mean deviation, axial length, central corneal thickness), and presence of glaucomatous progression upon DTA change.RESULTS: A total of 26 eyes of 26 young myopic primary open-angle glaucoma patients (axial length >24.0 mm; mean age, 25.1 ± 4.0 years; mean follow-up, 3.3 ± 0.9 years) were included. DTA was 7.0 ± 3.4 degrees at baseline and 8.3 ± 3.8 degrees at last visit, which represents a significant difference (p < 0.001). Worse VF mean deviation (p < 0.001) and longer axial length (p = 0.006) were significantly associated with DTA increase.CONCLUSIONS: Young myopic glaucomatous eyes showed progressive optic disc tilting. Progressive optic disc tilting in young myopic glaucomatous eyes may be related to either continuous axial myopic shift or glaucomatous structural change.

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.

Effects of Orbital Decompression on Lamina Cribrosa Depth in Patients with Graves' Orbitopathy

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.

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.

Analysis of Efficacy of Intravitreal Aflibercept According to Subfoveal Choroidal Thickness in Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. RESULTS: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 µm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 µm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 µm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). CONCLUSIONS: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.

Estrías angioides y tumor hipofisario: ¿asociación o hallazgo incidental? / Angioid streaks and pituitary tumor: ¿association or incidental finding?

Las estrias angioides de la retina se aprecian como líneas dentelladas rosadas u oscuras radiando irregularmente en todas direcciones desde el área peripapilar hacia la periferia de la retina. Corresponden a roturas del componente elástico de la membrana de Bruch. Su presencia indica una enfermedad sistémica siendo las más importantes el pseudoxantoma elástico, la enfermedad de Paget ósea y la drepanocitosis, Los tumores hipofisiarios raramente se han asociado a está condición existiendo apenas tres descriptores en la literatura. A estas adicionamos tres pacientes más, no obstante, aun no puede asegurarse si se trata de una asociación o de un simple hallazgo incidental.

Retinal angioid streaks can be seen as rough lines pink or dark, irregularly radiating in all directions from the peripapilar area to the periphery of the retina. They correspond of breaks in the elastic component of the Bruch membrane. Its presence indicates a systemic disease being the most important pseudoxanthoma elasticum, bone Paget's disease and sickle cell disease. Pituitary tumors have rarely been associated with this condition and exist just three descriptions in the literature. To these we add three more patients, however, still not be tightened if it's an association or a simple incidental finding.

Effect of Methyl-CpG binding domain protein 2 (MBD2) on AMD-like lesions in ApoE-deficient mice / 华中科技大学学报（医学）（英德文版）

The role of methyl-CpG binding domain protein 2 (MBD2) in an ApoE-deficient mouse model of age-related macular degeneration (AMD) was investigated. Eight-week-old Mbd2/ApoE double deficient (Mbd2(-/-) ApoE(-/-)) mice (n=12, 24 eyes, experimental group) and MBD2 (wt) ApoE(-/-) mice (n=12, 24 eyes, control group) were fed on Western-type diet for 4 months. The mice were sacrificed, and total serum cholesterol levels were analyzed and Bruch's membrane (BM) of the eyes was removed for ultrastructural observation by transmission electron microscopy. Moreover, intercellular adhesion molecule 1 (ICAM-1) immunoreactivities were evaluated by fluorescence microscopy in sections of the eyes in both groups for further understanding the function mechanism of MBD2. There was no significant difference in the total serum cholesterol levels between control group and experimental group (P>0.05). Transmission electron microscopy revealed that AMD-like lesions, various vacuoles accumulated on BM, notable outer collagenous layer deposits and dilated basal infoldings of retinal pigment epithelium (RPE) were seen in both groups, and the BM in control group was significantly thickened as compared with experimental group (P<0.05). Fluorescence micrographs exhibited the expression of ICAM-1 in choroid was higher in control group than in experimental group. We are led to conclude that MBD2 gene knockout may lead to accumulation of more deposits on the BM and influence the pathogenesis of AMD via triggering endothelial activation and inflammatory response in choroid, improving microcirculation, and reducing lipid deposition so as to inhibit the development of AMD-like lesions. Our study helps to provide a new therapeutic approach for the clinical treatment of AMD.

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.

Comparison of growth of human fetal RPE cells on electrospun nanofibers and etched pore polyester membranes / 中南大学学报(医学版)

OBJECTIVE@#To investigate and compare the growth of human fetal retinal pigment epithelial (RPE) cells seeded onto electrospun polyamide nanofibers (EPN) or etched pore polyester (EPP), and, further, to explore their possible use as prosthetic Bruch's membrane.@*METHODS@#Human fetal RPE cells were planted onto the EPN, EPP and plastic (control) substrates in Transwells. The cultures were assessed with respect to cell attachment at 2, 4, 8 hours and proliferation at 1, 4, 8 days after seeding. Growth and morphology of the cells were monitored under the phase contrast microscope, and the phenotype was identified by immunofluorescence staining with antibodies against tight junction protein ZO-1. Strips of single EPP coated with nothing or EPP coated with EPN was differently implanted into the subretinal space of two P21 RCS rats for two weeks and the histologic slides of the retina were assessed.@*RESULTS@#Cultured human fetal RPE cells were attached to either EPN or EPP substrates (with seeding on plastic substrate as control). After 8 h, the numbers of adherent cells in the EPN, EPP and control groups were 1.23*10(5)/cm(2), 1.70*10(5)/cm(2), and 1.64*10(5)/cm(2), respectively. The number of RPE cells attached to EPN was obviously less than that to both EPP and control (P<0.05). On the first day, the proliferation of cells on EPN was less than that of EPP and control (P<0.05); but by the 8th day in culture, the proliferation of cells on EPN had increased and was higher than proliferation on both EPP and control (P<0.05). All of the RPE cells cultured on EPN and EPP substrates were in monolayer, and the EPN-attached cells resembled the inner collagenous layer of Bruch's membrane. Immunofluorescence staining showed that the RPE cells cultured on EPN and EPP substrates adopted a higher expression of ZO-1 than that on the plastic control substrate. Subretinal implantation of either EPP alone or EPP as a carrier for free EPN for 2 weeks in P21RCS rats resulted in an expected encapsulation and loss of photoreceptor layer. No toxicity or other adverse reaction was observed in the vicinity of the transplant.@*CONCLUSION@#EPN and EPP could maintain human fetal RPE cell attachment and proliferation. Both EPN and EPP appeared to be grossly tolerance and biocompatible with subretinal implantation. EPN represents an intriguing prospect for prosthetic Bruch's membrane replacement because of its similarity in structure to native Bruch's membrane.

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.

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.

Bruch's membrane abnormalities in dome-shaped and mushroom-shaped choroidal melanomas

<p><b>INTRODUCTION</b>Mushroom-shaped choroidal melanoma is known to be associated with breaks in Bruch's membrane and is more likely to develop when Bruch's membrane is diseased. The study's goal is to determine if diseases causing breaks in Bruch's membrane predispose a choroidal melanoma to develop into a mushroom-shaped melanoma.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of cases of choroidal melanoma seen at our institution was carried out to determine if mushroom-shaped melanomas are more common than dome-shaped tumours in patients with macular abnormalities involving a loss of Bruch's membrane integrity. Forty-nine eyes of 48 patients were included in this retrospective study. A dome-shaped or mushroom-shaped configuration was assigned to each tumour. Macular degeneration, macular drusen, retinal pigment epithelial (RPE) stippling, macular oedema, choroidal neovascularisation (CNV), angioid streaks, disciform scars, lacquer cracks, and myopia greater than -3.00 D, were considered to constitute evidence of potential Bruch's membrane breaks and were determined in both eyes. A chi-square evaluation was used to compare the proportion of eyes with macular abnormalities in the 2 tumour configuration groups.</p><p><b>RESULTS</b>The tumour was dome-shaped in 40 eyes (82%) and mushroom-shaped in 9 eyes (18%). Macular abnormalities, indicative of loss of Bruch's membrane integrity, were seen in 21 (53%) of 40 eyes with dome-shaped melanomas and 5 (56%) of 9 eyes with mushroom-shaped melanomas. The proportion of eyes with macular abnormalities was not statistically different between the dome-shaped and mushroom-shaped tumours, as assessed by chi-square analysis (P = 0.87).</p><p><b>CONCLUSIONS</b>Bruch's membrane disease does not influence the differentiation of choroidal melanoma into mushroom-shaped or dome-shaped tumour growth patterns.</p>

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.

Age-related changes in the macula. A histopathological study of fifty Indian donor eyes.

PURPOSE: Age-related macular degeneration (ARMD) is clinically less common in India compared to the West. Therefore, clinicians are unfamiliar with histopathologic evidence of age-related macular changes in the Indian population. METHODS: Fifty consecutive human donor eyes removed for corneal grafting were studied for gross, microscopic and histochemical features of age-related changes in the macula in the Indian population. A horizontal block was cut from the globe including the optic disc, and the macula. Six sections, 6 microns thick, were cut from three levels in the macula at a distance of 140 microns. These were stained with haemotoxylin-eosin, periodic acid-Schiff, Mallory, Masson trichrome, alcian blue and von Kossa stains. The presence of basal laminar deposits, drusen and thickening and calcification of Bruch's membrane in the macula were assessed at 400 x magnification using a modified version of Sark's classification. RESULTS: Twenty-four donor eyes (48%) had some form of age-related macular change. These included basal laminar deposits, hard drusen, soft drusen, extensive retinal pigment epithelium atrophy of the macula, and disciform degeneration of macula. A combination of changes was often seen. Age-related changes were more common in the seventh and eighth decade. CONCLUSION: Our study shows that histological changes characteristic of the early stages of age-related macular degeneration are fairly common in the Indian population. However, advanced macular changes are significantly rare.

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.

Macular Hemorrhage after Laser in Situ Keratomileusis

Macular hemorrhage which result from breaks of Bruch's membrane or from choroidal neovascularization can develop in high degenerative myopia, but its occurrence after photorefractive surgery has rarely been reported. We experienced a case of macular hemorrhage after laser in situ keratomileusis[LASIK]:A 28-year-old female patient with high myopia of -16.5 diopters, who had received successful LASIK operation on her left eye.complained of a sudden drop in vision 20 days postoperatively.On fundus examination, macular hemorrhages were detected on her left eye.Eventually the hemorrhages resolved, but more than 2 lines of her best corrected visual acuity were lost.During follow-up, a new hemorrhagic lesion was incidently found on the other eye. This case demonstrates that macular hemorrhages may develop after LASIK in eyes with high degenerative myopia, and lead to a permanent reduction in visual acuity.We should be alert to any potential retinal pathology in patients having refractive surgery.

A Case of Lacquer Crack Formation at the Site of Subretinal Bleeding in High Myopic Eye

Lacquer cracks represent the healed mechanical breaks of retinal pigment epithelium, Bruch's membrane, and choriocapillaris complex.The etiologic mechanism of new lacquer cracks in high myopia has not yet been elucidated. Recently, cases in which new lacquer cracks formed at the site of the previous subretinal bleeding have been reported and it has been postulated that the subretinal bleeding may be the precursor of lacquer cracks formation in high myopia.Herein, we present our patient who developed a new lacquer crack at the site of previous subretinal bleeding with a brief literatures review.

Scanning Electron Microscopic Findings of Human Bruch's Membrane

Anatomical examinations on Bruch's membrane have almost been by light microscopy or transmission electron microscopy. Scanning electron microscopy allowed us to evaluate surface features topographically. Each layer of Bruch's membrane was exposed sequentially to mechanical or enzymatic treatment of the retinal pigment epithelium choroid complex from human cadavar eye. The authors examined the surface features of the membrane by dry-cracking scanning electron microscopy. The basement membrane of retinal pigment epithelium appeared like a smooth thin plastic membrane which was framed by collagen fibers. The inner collagenous layer was composed of many collagen fiber bundles which were placed in order and the ground substance between them was not visible. Elastic layer of Burch's membrane appeared to be coarse and fine fibers matted together by some amorphous substance. This layer had many openings on its solid sheet and the outer collagenous zone was visible though these openings.

Estrias angiódes / Angioid streaks

Estrias angióides são alterações da membrana basal do epitélio pigmentar retiniano, que estão associadas com doenças sistêmicas ou são de causa idiopática. Foi estudado o caso de uma paciente portadora de pseudoxantoma elástico e estrias angióides, com dez anos de evolução. A paciente apresentava diminuição da acuidade visual, estrias angióides e fibrose subretiniana, associado a alterações cutâneas sistêmicas. devido a aus6encia de um tratamento específico, a paciente evoluiu com intensa fibrose subretiniana e atrofia coriocapilar