In view of the limited native RPE resurfacing observed in areas of localized RPE debridement using organ cultures of aged submacular human Bruch's membrane , ECM ligand bioavailability is likely compromised in the submacular area of aged human eyes.
The availability of techniques to manufacture surfaces that are biocompatible and that exhibit ECM ligands supporting cell attachment, proliferation, and survival renders biochemical reconstruction of Bruch's membrane a viable approach for managing RPE cell loss after surgical excision of CNVs as well as in cases of geographic atrophy [35-36].
Virtually any pathologic process that involves the choroid and damages the RPE and Bruch's membrane can result in a CNVM.
Choroidal rupture usually occurs after blunt trauma and is identified as a tear in the choroid, Bruch's membrane, and RPE that appears as a yellow or white crescent-shaped subretinal streak, usually concentric to the optic disc.
Retinal pigment epithelial detachment (PED) is a common finding in both dry and wet AMD, formed by separation of the RPE from Bruch's membrane
due to the presence of sub-RPE fluid, blood, fibrovascular membrane or drusenoid material.
The response to CA4P in this patient with subfoveal choroidal neovascularization due to myopic degeneration suggests that CA4P should be tested in all the conditions in which breaks in Bruch's membrane
lead to subfoveal choroidal neovascularization.
Campochiaro and his colleagues concluded, "In this study, we have demonstrated that a tubulin-binding agent, CA-4-P, suppresses the development of subretinal neovascularization in rhodopsin/VEGF transgenic mice and suppresses the development of CNV at Bruch's membrane
is not normally discernable from the RPE.
In its "dry" form it is a degeneration affecting Bruch's membrane
and the retinal pigment epithelium (RPE), with secondary changes in the retina.
AMD affects the outer retina, retinal pigment epithelium (RPE), Bruch's membrane
and the choroid, culminating in the death of macular photoreceptors and central visual loss.
The choroid is part of the uveal tract, and is divided into three layers--the vessel layer, capillary layer and Bruch's membrane
The RPE consists of a single layer of cells and is positioned between the photoreceptors and Bruch's membrane
(see figures 4 and 5).