Peripapillary chorioretinal atrophy - Bruch's membrane changes and photoreceptor loss

Purpose: To determine relationships among Bruch's membrane ultrastructure, photoreceptor degeneration, and choriocapillaris atrophy with respect to zo nes of retinal pigment epithelium (RPE) degeneration and atrophy adjacent t o the optic nerve head, as a function of age. Design: 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 c ondition. Methods: Sections through the retina-choroid complex at the temporal aspect of the optic nerve head were used for light microscopic histopathologic an alysis (n = 17), electron microscopy (n = 9), carbonic anhydrase histochemi cal analysis (n = 7), and lipid histochemical analysis (n = 22). Retinal wh ole mounts were used for photoreceptor counts (n = 5). Main Outcome Measures: We determined the width of RPE degeneration and atro phy, the number of eyes with abnormalities of inner Bruch's membrane, and t he number of rod and cone photoreceptors within 1 mm of the disc margin. We determined whether Bruch's membrane changes, photoreceptor degeneration, a nd choriocapillaris atrophy were associated with RPE degeneration and atrop hy. Results: All eyes had peripapillary RPE atrophy, degeneration, or both. The zone of RPE atrophy widened significantly after age 75. Thickening of inne r Bruch's membrane and abnormalities of the RPE basal lamina were associate d with degenerating and atrophic RPE in all eyes. The RPE basal lamina was narrow, reduplicated, or thickened as a basal laminar deposit. All eyes exh ibited degeneration and loss of rods but not cones at the peripapillary ter mination of Bruch's membrane. Diminution of choriocapillaris coverage of Br uch's membrane was associated with RPE degeneration. Complete loss of the c horiocapillaris was associated with RPE atrophy. Conclusions: Our results suggest that peripapillary chorioretinal atrophy i s an age-related degeneration of the RPE-Bruch's membrane complex that rese mbles that found in the macula and periphery of normal eyes. (C) 2000 by th e American Academy of Ophthalmology.