Clinicopathologic correlation of drusen and retinal pigment epithelial abnormalities in age-related macular degeneration
Abstract
Background: Clinicopathologic studies of eyes lead to a better understanding of the nature of the ophthalmoscopic and fluorescein angiographic features of drusen. A study was conducted to provide clinicopathologic correlation of drusen and present a classification of drusen based on clinical and histopathologic features. Methods: The macular areas of three eyes from two patients were serially sectioned and studied, and features were depicted in a two-dimensional map and compared with clinical findings. Results: All three tyes had large drusen (>63 µm) with soft morphologic characteristics (poorly demarcated borders) documented on fundus photographs. In both eyes from one patient, these large drusen corresponded to areas of focal retinal pigment epithelium hypopigmentation overlying Bruch's membrane, which was diffusely thickened throughout the macula. Similar findings were noted in another eye from a second patient, and additionally, where there was relatively marked fluorescein staining of large drusen on the late phase of an angiogram, the pathologic correlation demonstrated detachment of the thickened inner aspect of Bruch's membrane from the remainder of Bruch's membrane. Focal hyperpigmentation corresponded to areas of hypertrophy of the retinal pigment epithelium and to clusters of pigmented cells in the subretinal space and outer nuclear area. Conclusion: Diffuse thickening of the inner aspect of Bruch's membrane is associated with retinal pigment epithelial hypopigmentation, focal atrophy, and soft (large) drusen formation.
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Soft drusen are often large and are associated with the detachment of the retinal pigment epithelium and diffusely abnormal Bruch's membrane alterations.
“Soft drusen are often large and are associated with the detachment of the retinal pigment epithelium and diffusely abnormal Bruch’s membrane alterations.122,124”
From Age-related macular degeneration (2008) · cites this paper as [124]
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The Immunological Basis of Degenerative Diseases of the Eye
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“Large drusen and the associated RPE changes are the major risk factors for the development of advanced AMD, which can be classified into two subtypes: dry and wet [2, 3].”
BackgroundBerinstein, D. M., Hassan, T., Williams, G. A., Margherio, R. R., Ruby, A. J., & Garretson, B. R. (2000) · Ophthalmology · doi:10.1016/s0161-6420(00)00417-6 · Cited by 26 · see citing works
Neovascular (Exudative) Age-Related Macular Degeneration
Bressler, N. M., Bressler, S. B., & Fine, S. L. (2006) · Elsevier eBooks · doi:10.1016/b978-0-323-02598-0.50067-7 · Cited by 29 · see citing works
Self-citationSheibani, N., Farnoodian, M., & Sorenson, C. (2018) · Journal of Ophthalmic and Vision Research · doi:10.4103/jovr.jovr_67_18 · Cited by 26 · see citing works
“[142,145] The limitations with PDT include a low rate of vision improvement in patients (only 14%) and high incidence of CNV recurrence after laser treatment.[142,145] Extensive research on the molecular and cellular mechanisms involved in AMD pathogenesis and CNV has provided a better understanding of disease develop…”
BackgroundJawad, S., Liu, B., Li, Z., Katamay, R., Campos, M. M., Wei, L., Sen, H. N., Ling, D., Martínez, F. O., Amaral, J., et al. (2013) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.12-11380 · Cited by 25 · see citing works
Polypoidal choroidal vasculopathy with drusen
Iwama, D., Tsujikawa, A., Sasahara, M., et al. (2008) · Japanese Journal of Ophthalmology · doi:10.1007/s10384-007-0503-9 · Cited by 24 · see citing works
“In addition, drusen often disappear beneath a longstanding detached retina because they are byproducts of rod and cone metabolism of the RPE.24 In this study, we evaluated patients with PCV who had drusen in at least one eye, because the presence of drusen is reported to often be symmetric, that is, to involve both ey…”
BackgroundInfluentialDrusen, an Old but New Frontier
Spaide, R. F., Curcio, C. A., & Zweifel, S. A. (2010) · Retina · doi:10.1097/iae.0b013e3181ed8d05 · Cited by 22 · see citing works
Sanie‐Jahromi, F., Ahmadieh, H., Soheili, Z., Davari, M., Ghaderi, S., Kanavi, M. R., Samiei, S., Deezagi, A., Pakravesh, J., & Bagheri, A. (2012) · BMC Research Notes · doi:10.1186/1756-0500-5-182 · Cited by 22 · see citing works
“A number of treatments have previously been used, some of which, in addition to not being suitable for retinal restoration, have been found to affect the adjacent healthy cells [5-8].”
BackgroundAge-Related Macular Degeneration
Hagedorn, C. L., & Adelman, R. A. (2007) · Humana Press eBooks · doi:10.1007/978-1-59745-047-8_1 · Cited by 24 · see citing works
Khan, K. N., Borooah, S., Landó, L., Dans, K., Mahroo, O. A., Meshi, A., Kalitzeos, A. A., Agorogiannis, G., Moghimi, S., Freeman, W. R., et al. (2020) · Translational Vision Science & Technology · doi:10.1167/tvst.9.6.26 · Cited by 21 · see citing works
SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING OF DRUSENOID PIGMENT EPITHELIAL DETACHMENTS
Filho, C. A. D. A. G., Yehoshua, Z., Gregori, G., Farah, M. E., Feuer, W. J., & Rosenfeld, P. J. (2013) · Retina · doi:10.1097/iae.0b013e318285cbd2 · Cited by 21 · see citing works
“nine green angiography; spectral-domain optical coherence tomography (SD-OCT); and histopathology.(2,3) Drusenoid pigment epithelial detachments carry a better prognosis when compared with vascularized”
BackgroundMcgill, T., Osborne, L., Lu, B., Stoddard, J., Huhn, S., Tsukamoto, A., & Capela, A. (2019) · Translational Vision Science & Technology · doi:10.1167/tvst.8.3.43 · Cited by 17 · see citing works
“AMD with GA.(41) Our data in this study suggested a role for HuCNS-SC in augmenting that putative regenerative capacity, particularly in the context of AMD with GA.”
BackgroundScanning and transmission electron microscopic findings during RPE wound healing in vivo
Oganesian, A., Bueno, E., Yan, Q., Spee, C., Black, J., Rao, N. A., & Lopez, P. F. (1997) · International Ophthalmology · doi:10.1023/a:1026402031902 · Cited by 20 · see citing works
“focal hyperpigmentation [63, 64] in choroidal neovascularization [26, 29, 30, 64] associated with the”
BackgroundHomeostasis and dyshomeostasis of the retina
Zhang, C.-J., & Jin, Z. (2023) · Current Medicine · doi:10.1007/s44194-023-00021-6 · Cited by 23 · see citing works
- Authors
- BRESSLER, N. M., SILVA, J. C., BRESSLER, S. B., FINE, S. L., & GREEN, W. R.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- BRESSLER, NEIL M.
- BRESSLER, SUSAN B.
- FINE, STUART L.
- Venue
- Retina
- Published
- 1994
- Volume
- 14
- Issue
- 2
- Pages
- 130-142
- ISSN
- 0275-004X (ISSN-L)
- OpenAlex
- W4234378667
- Cited by
- 200
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 12 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 9 · 2017: 7 · 2016: 5 · 2015: 10 · 2014: 5 · 2013: 7 · 2012: 11
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Retina (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- drusen, age-related macular degeneration, retinal pigment epithelium, retinal pigment epithelium atrophy, clinicopathological correlation, outer nuclear layer
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