CNV results from damage to Bruch's membrane
and RPE defects.
The intracellular lipid accumulation in RPE leads to AMD that appears in the form of Bruch's membrane
deposits and drusen.25
In Bruch's membrane
, tightly coupled processes of synthesis and degradation serve to continuously turn over the ECM of the membrane, thereby maintaining its structural and functional characteristics.
ILM: internal limiting membrane, IS/OS: inner segment/outer segment, and BM: Bruch's membrane
In addition to the strong age dependence of the disease, complex interactions between metabolic, functional, genetic, and environmental factors create a platform for the development of chronic changes in the ocular structures of the macular region (e.g., choriocapillaris, Bruch's membrane
, RPE, and photoreceptors), and changes in each of these structures may contribute to varying degrees to the onset of AMD (Figure 2).
The earliest clinical manifestation and pathological feature of AMD is the development of extracellular deposits called drusen located inside Bruch's membrane
(BM) and beneath the retinal pigment epithelium (RPE).
The presumed pathogenesis is pressure deformity of the border of Bruch's membrane
at the level of the optic nerve head creating a discontinuity of the normal anatomic apposition of the chorioretinal layers.
The novel technique stimulates enzymes to eradicate waste material from a thin membrane behind the retina, called Bruch's membrane
Pseudoxanthoma elasticum is an autosomally inherited disorder associated with the accumulation of mineralized and fragmented elastic fibers in the skin, Bruch's membrane
in the retina, and vessel walls.
However, visual recovery after CNV excision in AMD patients is usually poor because of removal of adjacent native retinal pigment epithelium (RPE) and damage to the subjacent Bruch's membrane
(i.e., removal of the RPE basement membrane and, to varying degrees, portions of the inner collagenous layer [ICL] of the Bruch's membrane
) [15-16] as well as incomplete RPE growth into the dissection bed with subsequent choriocapillaris and photoreceptor atrophy [15,17].
Yellow deposits called "drusen" form under the retina between the retinal pigmented epithelium (RPE) and the Bruch's membrane
, which supports the retina.