Curcio C A, Saunders P L, Younger P W, Malek G
Department of Ophthalmology, University of Alabama at Birmingham, 35294-0009, USA.
Ophthalmology. 2000 Feb;107(2):334-43. doi: 10.1016/s0161-6420(99)00037-8.
To determine relationships among Bruch's membrane ultrastructure, photoreceptor degeneration, and choriocapillaris atrophy with respect to zones of retinal pigment epithelium (RPE) degeneration and atrophy adjacent to the optic nerve head, as a function of age.
Human tissue study using clinicopathologic correlation. TISSUES: Eyes from patients 36 to 93 years of age lacking clinical evidence of glaucoma, optic nerve abnormalities, severe myopia, age-related macular degeneration, or other macular or peripapillary chorioretinal pathologic condition.
Sections through the retina-choroid complex at the temporal aspect of the optic nerve head were used for light microscopic histopathologic analysis (n = 17), electron microscopy (n = 9), carbonic anhydrase histochemical analysis (n = 7), and lipid histochemical analysis (n = 22). Retinal whole mounts were used for photoreceptor counts (n = 5).
We determined the width of RPE degeneration and atrophy, the number of eyes with abnormalities of inner Bruch's membrane, and the number of rod and cone photoreceptors within 1 mm of the disc margin. We determined whether Bruch's membrane changes, photoreceptor degeneration, and choriocapillaris atrophy were associated with RPE degeneration and atrophy.
All eyes had peripapillary RPE atrophy, degeneration, or both. The zone of RPE atrophy widened significantly after age 75. Thickening of inner Bruch's membrane and abnormalities of the RPE basal lamina were associated with degenerating and atrophic RPE in all eyes. The RPE basal lamina was narrow, reduplicated, or thickened as a basal laminar deposit. All eyes exhibited degeneration and loss of rods but not cones at the peripapillary termination of Bruch's membrane. Diminution of choriocapillaris coverage of Bruch's membrane was associated with RPE degeneration. Complete loss of the choriocapillaris was associated with RPE atrophy.
Our results suggest that peripapillary chorioretinal atrophy is an age-related degeneration of the RPE-Bruch's membrane complex that resembles that found in the macula and periphery of normal eyes.
确定在视网膜色素上皮（RPE）紧邻视神经乳头处发生退变和萎缩的区域内，Bruch膜超微结构、光感受器退变和脉络膜毛细血管萎缩之间的关系，并将其作为年龄的函数。
采用临床病理相关性的人体组织研究。
取自年龄在36至93岁患者的眼睛，这些患者缺乏青光眼、视神经异常、高度近视、年龄相关性黄斑变性或其他黄斑或视乳头周围脉络膜视网膜病理状况的临床证据。
在视神经乳头颞侧的视网膜 - 脉络膜复合体切片用于光学显微镜组织病理学分析（n = 17）、电子显微镜检查（n = 9）、碳酸酐酶组织化学分析（n = 7）和脂质组织化学分析（n = 22）。视网膜全层铺片用于光感受器计数（n = 5）。
我们确定了RPE退变和萎缩的宽度、Bruch膜内层异常的眼睛数量以及视盘边缘1毫米内视杆和视锥光感受器的数量。我们确定了Bruch膜变化、光感受器退变和脉络膜毛细血管萎缩是否与RPE退变和萎缩相关。
所有眼睛均有视乳头周围RPE萎缩、退变或两者皆有。75岁以后，RPE萎缩区域显著增宽。Bruch膜内层增厚以及RPE基底层异常与所有眼睛中RPE的退变和萎缩相关。RPE基底层变窄、重复或增厚形成基底膜沉积物。所有眼睛在Bruch膜视乳头周围终末处均表现出视杆细胞的退变和丧失，但视锥细胞未受影响。Bruch膜脉络膜毛细血管覆盖减少与RPE退变相关。脉络膜毛细血管完全丧失与RPE萎缩相关。
我们的结果表明，视乳头周围脉络膜视网膜萎缩是一种与年龄相关的RPE - Bruch膜复合体退变，类似于正常眼睛黄斑和周边区域所见。
