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Ageing and degeneration in the macular region: A clinico-pathological study
Open accessAbstract
Clinical and pathological examination was performed on 378 eyes from 216 patients aged 43 to 97 years. This series represented eyes in which the fundi were normal or showed various manifestations of senile macular degeneration. The eyes were divided into six groups according to the histological appearance of a linear deposit at the base of the retinal pigment cells. Groups I and II were considered to represent normal ageing, Groups III and IV the progressive development of senile macular degeneration and Groups V and VI the end-results. Group I showed no basal linear deposit. Thickening and hyalinization of Bruch's membrane was noted as early as the fifth decade. Group II showed patchy development of the basal linear deposit in relation to thickened or basophilic segments of Bruch's membrane, or over intercapillary hyalinization extending to the level of the outer surface of the choriocapillaris. Almost all eyes in these two groups retained a normal fundus appearance but visual acuity declined with age even in the absence of other causes. In Group III the basal deposit formed a thin continuous layer associated with moderate degeneration of the retinal pigment epithelium. More than half the eyes had developed a clinical disturbance of pigmentation and in most vision was reduced. Group IV was characterized by thickening of the deposit and more pronounced disturbance of the pigment epithelium. Clinically most eyes showed coarse pigmentary changes and vision was in the order of 6/24. 14-3 per cent of eyes in this group showed early neovascularization from the choroid. In Group V the pigment epithelium disappeared to produce circumscribed areas of depigmentation. The basal linear deposit could be traced throughout the depigmented area in most eyes. Thin fibrovascular sheets were found beneath the pigment epithelium in 41-7 per cent of eyes. Group VI represented disciform degeneration. The basal linear deposit could often be demonstrated as a disrupted hyalinized layer incorporated into the scar. Disciform degeneration was an alternative end-result to geographical atrophy. In each group the clinical and histological findings may be modified by the presence of drusen or by atrophy of the choroid. The basal linear deposit consisted of banded fibres embedded in granular material lying between the plasma infoldings and the basement membrane of the retinal pigment epithelium. This deposit seems to be a manifestation of gradual failure of the pigment epithelium and proved to be the most suitable criterion by which to study the natural history of senile macular degeneration.
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In the citing paper
“BrM undergoes thickening with ageing [29,45,46,47], detectable using modern ophthalmic imaging (Figure 2).”
From Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration (2023) · cites this paper as [45]
In the citing paper
“Advanced AMD can be broadly classified into two clinical forms: neovascular AMD and geographic atrophy [45].”
From Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration (2023) · cites this paper as [45]
In the citing paper
“Cholesterol and calcium have been found to accumulate in Bruch’s membrane throughout adulthood (Sarks, 1976; Curcio et al., 2001; Pauleikhoff et al., 1990).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“Drusen are subretinal extracellular deposits composed of glycoproteins and lipids in the inner collagenous zone of Bruch’s membrane (Sarks, 1976).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“At the ultrastructural level, drusen are a fine, granular, amorphous material the same electrodensity of the RPE basement membrane with vesicles, tubular structures, curly membranes and abnormal collagen (Sarks, 1976).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“BlinD are a more specific marker of AMD progression to late disease, and BlamD are a more reliable indicator of RPE atrophy and photoreceptor degeneration (van der Schaft et al., 1992; Curcio and Millican, 1999; Sarks, 1976).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“There is an age-related increase in thickness in Bruch’s membrane and the internal limiting membrane (Sarks, 1976; Ding et al., 2009).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“Photoreceptor cell loss is most prominent in the parafovea and can progress to total photoreceptor loss and disciform degeneration (Curcio et al., 1996; Sarks, 1976; Shelley et al., 2009).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“Additionally, sclerosis of the choriocapillaris is found without breaks in Bruch’s membrane (Sarks, 1976).”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“another strain of SAM mice with a longer life-span, SAMR1 mice, have age-related retinal pathology reminiscent of AMD”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
In the citing paper
“Most AMD cases have regional cone photoreceptor loss”
From Retinal ultrastructure of murine models of dry age-related macular degeneration (AMD) (2010) · cites this paper as Sarks, 1976
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Metadata
- Authors
- Sarks, S. H.
- Affiliations
- Bankstown Lidcombe Hospital (AU)
- Corresponding author
- Sarks, S H
- Venue
- British Journal of Ophthalmology
- Publisher
- BMJ
- Published
- 1976-05-01
- Volume
- 60
- Issue
- 5
- Pages
- 324-341
- ISSN
- 0007-1161 (ISSN-L)
- PMC
- PMC1042725
- OpenAlex
- W1980954887
- Cited by
- 891
- References
- 18
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 15 · 2023: 18 · 2022: 22 · 2021: 25 · 2020: 32 · 2019: 22 · 2018: 27 · 2017: 33 · 2016: 21 · 2015: 33 · 2014: 28 · 2013: 18 · 2012: 30
- FWCI
- 11.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Ophthalmology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ophthalmic Research Institute of Australia
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Retinal Development and Disorders
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- senile macular degeneration, retinal pigment epithelium degeneration, choroidal neovascularization, drusen, choroidal atrophy, aging, visual acuity loss, pigmentary changes
- MeSH terms
- Adult, Aged, Aging, Choroid, Female, Fundus Oculi, Humans, Macula Lutea, Macular Degeneration, Male, Microscopy, Electron, Middle Aged, Pigment Epithelium of Eye, Retinal Degeneration, Visual Acuity
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