Green W R, McDonnell P J, Yeo J H
Ophthalmology. 1985 May;92(5):615-27.
Senile macular degeneration (SMD) has several morphologic forms that may exist singly or in various combinations. Patients with drusen are at an increased risk to develop SMD. Types of drusen that have been recognized clinically and histopathologically include hard or nodular, soft, glistening or calcified, and diffuse. Hard drusen are probably a consequence of extrusion of material from one or a cluster of retinal pigment epithelial (RPE) cells. Soft drusen are a sign of more widespread disease of the RPE, develop in eyes with hard drusen, and represent small areas of serous detachment of the RPE and the thickened inner aspect of Bruch's membrane. RPE areolar atrophy can occur in the setting of hard and soft drusen and in larger RPE detachments. From the morphologic point of view, we propose that the process leading to disciform scar formation in SMD begins with thickening of the inner aspect of Bruch's membrane due to production of abnormal basement membrane by the RPE. This thickened area is weakly attached and allows the development of localized detachments (soft drusen). These localized detachments become confluent into large detachments of the RPE. Choroidal neovascularization occurs in association with diffuse and soft drusen and larger serous RPE detachments. Bleeding from neovascular tissue leads to disciform scar formation.
老年性黄斑变性（SMD）有几种形态学类型，它们可以单独存在或以各种组合形式存在。患有玻璃膜疣的患者发生SMD的风险增加。临床上和组织病理学上已识别的玻璃膜疣类型包括硬性或结节状、软性、闪亮或钙化以及弥漫性。硬性玻璃膜疣可能是一种或一群视网膜色素上皮（RPE）细胞挤出物质的结果。软性玻璃膜疣是RPE更广泛疾病的迹象，在有硬性玻璃膜疣的眼中出现，代表RPE的小面积浆液性脱离和Bruch膜内侧面增厚。RPE蜂窝状萎缩可发生在硬性和软性玻璃膜疣以及较大的RPE脱离的情况下。从形态学角度来看，我们提出导致SMD中盘状瘢痕形成的过程始于RPE产生异常基底膜导致Bruch膜内侧面增厚。这个增厚区域附着较弱，会导致局部脱离（软性玻璃膜疣）的发展。这些局部脱离融合成RPE的大脱离。脉络膜新生血管形成与弥漫性和软性玻璃膜疣以及较大的浆液性RPE脱离有关。新生血管组织出血导致盘状瘢痕形成。
