Posterior scleritis must be one of the most underdiagnosed treatable conditions in ophthalmology, partly because its manifestations are so protean and partly because the diagnosis is rarely considered. Although ultrasonography and computer tomogram are ancilliary tests, a careful examination of the posterior segment of the eye including the area of the ora serrata, macula and disc is essential to discover the presence of a posterior scleritis. We experienced prolonged retinal pigment epithelial detachments which had appered at early phase of posterior scleritis.
Bruch Membrane ; Diagnosis ; Ophthalmology ; Retinal Detachment* ; Retinaldehyde* ; Scleritis* ; Ultrasonography

Laser photocoagulation was applied in vitro to organ culture exoplants of porcine retinal pigment epithelium(RPE) attached to Bruch's membrane, choroid, and sclera using the Del Priore method for de-monstrating the proliferation of RPE cells and characterizing the response with respect to power level of treatment. Six-millimetor-round buttons of eyewall were treated with 20-30 spots from the argon bluegreen laser using a 500 micrometer spot size, 0.1s duration, and variable powers(100mW, 300mW, and 500mW). Group 1 is untreated control group and group 2(100mW) and group 4(500mW) showed less active proliferation of RPE than group 3(300mW). In group 3, all RPE cells, Bruch's membrane, and a part of choroid were disrupted and lifted off three hours after laser photocoagulation and then RPE cells began to proliferate actively at third day. The treated area became completely covered with several layers of RPE cells. The proliferation of RPE cells turned out to be larger when the power was moderate(300mW) as compared to the case when the power was too high(500mW) or too low(100mW).
Argon ; Bruch Membrane ; Choroid ; Light Coagulation* ; Organ Culture Techniques* ; Retinal Pigment Epithelium* ; Retinaldehyde* ; Sclera

PURPOSE: To evaluate the effect of intravitreal aflibercept according to subfoveal choroidal thickness in patients with polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively analyzed the medical records of 60 eyes from 60 patients with PCV treated with intravitreal aflibercept. The patients were followed for at least 6 months after the first injection. Using software, subfoveal choroidal thickness was manually measured as the distance from the hyper-reflective line of Bruch's membrane to the chorioscleral interface on optical coherence tomography. The patients were divided into three groups based on subfoveal choroidal thickness. Visual acuity, subfoveal choroidal thickness, central macular thickness and largest pigment epithelial detachment (PED) height, polyp regression rate, and dry macula rate were evaluated to analyze the anatomical and functional outcomes. RESULTS: Baseline mean subfoveal choroidal thickness were 178.50 ± 28.42 µm in the thin group (14 eyes, 23.3%), 287.03 ± 43.58 µm in the medium group (33 eyes, 55.0%), and 379.77 ± 17.09 µm in the thick group (13 eyes, 21.7%). Baseline age, sex, visual acuity, central macular thickness, and the largest PED height did not differ significantly among the three subgroups. Only the thin group showed significant improvement of visual acuity at 6 months (p = 0.005). Subfoveal choroidal thickness, central macular thickness, and largest PED height were significantly decreased after treatment in all subgroups and did not differ among the subgroups. Compared with the other groups, the thin subfoveal choroidal thickness group showed higher polyp regression rate at 3 months and higher dry macula rate at 6 months (p = 0.013 and p = 0.004, respectively). CONCLUSIONS: Intravitreal aflibercept injection was effective for the treatment of PCV, and thin subfoveal choroidal thickness was associated with better anatomical and functional outcomes.
Bruch Membrane ; Choroid* ; Humans ; Medical Records ; Polyps ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

We studied clinical applicability of the contact transscleral retinopexy using the continuous-wave Nd:YAG (CW-YAG) laser. CW-YAG laser photocoagulation was done over sclera through contact probe in the pigmented rabbit eyes. Cryoretinopexy was also done and their morphologic findings were compared. Acute lesions produced with the laser photocoagulation were noted to have the characteristic white-colored distinct depigmentation. Its microscopic findings were oharacterized by choroidal necrosis, disruption of Bruch's membrane, dispersion of retinal pigment epithelial cells, and disorganization of sensory retina. Acute lesions after the cryoretinopexy were much more broader in its area and showed slight tanslucent retinal edema. Its microscopic findings showed relatively well-preserved choroid including Bruch's membrane. These data demonstrated that the contact transscleral CW-YAG laser retinopexy is capable of inducing more localized, stronger chorioretinal adhesion than the cryoretinopexy.
Bruch Membrane ; Choroid ; Diathermy ; Epithelial Cells ; Light Coagulation ; Necrosis ; Papilledema ; Retina ; Retinaldehyde ; Sclera

Folding of the choroid, Bruchs membrane, and the overlying retina may occur in a variety of ocular and orbital diseases and after certain surgical procedures. A 34-year-old man experienced the decreased visual acuity and the protrusion and displacement in the right eye for at least 4 years. The protrusion of the patient was 13mm in the right eye and 6mm in the left eye with the aid of Hertels exophthalmometer. The right eye appeared downward deviation about 15 prism. The tumor located outside the muscle cone in the computed tomography and ultrasonography seemed to make the large choroidal folds involving the macula region. The retinal pigment epithelial atrophy was noted along long-standing choroidal folds. The tumor was removed by the lateral orbitotomy. The size of tumor was 20 x 15x 10mm. The postoperative protrusion was 6mm in the both eye. After removal of tumor, changes in the corneal refraction, visual acuity, and choroidal folds with the retinal pigment epithelial atrophy did not occur in comparison with the preoperative state.
Adult ; Atrophy ; Bruch Membrane ; Choroid* ; Humans ; Orbit* ; Orbital Diseases ; Retina ; Retinaldehyde ; Ultrasonography ; Visual Acuity

The choroidal vascular system in human eyes has been studied in flat preparation and fluorescein angiography to elucidate the choroidal circulation in normal and in disease state. The histopathologic studies were performed in view of vascular interconnection, regional differences, choriocapillaris pattern, and drusen and hole in Bruch's membrane. The interarterial and intervenous communications are demonstrated. The short posterior ciliary artery angulates around the disc margin and makes an anastomosis between surrounding short posterior ciliary artery. The segment of the choriocapillaris is supplied by a central terminal arterioles and drained by a venule at its margin. The thickened cuticular layer of Bruch's membrane may be associated with sclerosis of the choriocapillaris. Holes in the Bruch's membrane may contribute to invasion of the choroidal vessel into the subretinal space leading to subretinal neovascularization. Based on fluorescein angiography, a segmental supplies by short posterior ciliary artery, peripapillary choroidal arterial system, peripapillary choroidal filling pattern and vasculitis of the choroid have been worked out.
Arterioles ; Bruch Membrane ; Choroid* ; Ciliary Arteries ; Equipment and Supplies ; Fluorescein Angiography ; Humans ; Sclerosis ; Vasculitis ; Venules

The choroidal vascular system in human eyes has been studied in flat preparation and fluorescein angiography to elucidate the choroidal circulation in normal and in disease state. The histopathologic studies were performed in view of vascular interconnection, regional differences, choriocapillaris pattern, and drusen and hole in Bruch's membrane. The interarterial and intervenous communications are demonstrated. The short posterior ciliary artery angulates around the disc margin and makes an anastomosis between surrounding short posterior ciliary artery. The segment of the choriocapillaris is supplied by a central terminal arterioles and drained by a venule at its margin. The thickened cuticular layer of Bruch's membrane may be associated with sclerosis of the choriocapillaris. Holes in the Bruch's membrane may contribute to invasion of the choroidal vessel into the subretinal space leading to subretinal neovascularization. Based on fluorescein angiography, a segmental supplies by short posterior ciliary artery, peripapillary choroidal arterial system, peripapillary choroidal filling pattern and vasculitis of the choroid have been worked out.
Arterioles ; Bruch Membrane ; Choroid* ; Ciliary Arteries ; Equipment and Supplies ; Fluorescein Angiography ; Humans ; Sclerosis ; Vasculitis ; Venules

PURPOSE: To compare the cultured morphology of retinal pigment epithelium (RPE) cells which were transplanted onto the Bruch's membrane (BM) in different tissue types. METHODS: Cultured porcine RPE cells were harvested in three types of transplants: single cell (SC) suspension, cell cluster (CC) suspension and cell sheet (CS). After RPE cell transplants were plated onto the porcine BM explants at three different cell concentrations, they were dissected and examined with a transmission electron microscope and a scanning electron microscope at 1 day, 3 days, and 1, 2 and 4 weeks for morphological study. RESULTS: All types of RPE transplants were grown and proliferated well on BM and required a shorter time to reach confluence with higher cell concentration. Although CC transplants took a little longer to reach confluence on BM than SC transplants, they were nevertheless well grown on BM and showed good cellular morphology in monolayer. The time to confluence was much longer for the CS transplants than for the SC and CC transplants and the proliferated cells tended to be large, flat and to have scanty microvilli on the cell surface with reaching peripheral portion of confluent cell layers. CONCLUSIONS: CC suspension may be a better candidate for RPE transplantation in the case of using cultured RPE cells as transplant.
Bruch Membrane* ; Epithelial Cells* ; Microvilli ; Retinal Pigment Epithelium ; Retinaldehyde* ; Transplantation ; Transplants

Changes in the thickness and composition of Bruch's membrane with aging have been described by several observers and related to the development of macular with advancing ageby region, comparing the macular area with more peripheral areas. In the younger (less than. 50 years) eyes we studied, the thickness of macular Bruch's membrane was about equal to that of peripheral Bruch's membrane. With aging, however, the thickness of Bruch's membrane was greater in the periphery than the macula. With increasing age, Bruch's membrane increased in basophilic reaction, PAS positivity and the detectable sialomucin fraction. In the macular region, but not in more peripheral regions, there is a preferential thickening of the interchoriocapillaris "teeth" of Bruch's degeneration by some. Using a combination of histochemical and electronmicroscopic techniques, we have examined the state of Bruch's membrane membrane material. By electronmicroscopy, in older eyes, the elastin layer of Bruch's membrane appears fragmented, while, in the periphery, it is continuous and resembles that of younger eyes. In summary, Bruch's membrane exhibits little regional difference in thickness in younger eyes, but the macular region becomes relatively thinner than more peripheral regions in older eyes. With advancing age, the deposition of extracellular matrix materials in appatite and fragmentation of the elastin layer is dramatically more prominent in the macular region than in the periphery. This regional variation may be related, at least in part, to some aspects of macular degeneration.
Aging ; Basophils ; Bruch Membrane* ; Elastin ; Extracellular Matrix ; Humans* ; Macular Degeneration ; Membranes ; Periodic Acid-Schiff Reaction ; Sialomucins

PURPOSE: To analyze the structural changes in the beta-zone of peripapillary atrophy (PPA-beta) using cross-sectional image of the optic disc head from spectral-domain optical coherence tomography (SD-OCT) according to the optic disc shape. METHODS: One hundred thirty-seven eyes in 137 patients with glaucoma having PPA-beta and 31 normal eyes (control group) were evaluated retrospectively. Cross-sectional images of the optic disc were taken using the Cirrus HD-OCT. We classified optic disc patterns into normal, focal, myopic, generalized enlargement and senile sclerotic appearance types and analyzed the shape of Bruch's membrane (BM), composition of retinal layer and retinal slope according to the optic disc shape. RESULTS: Among the 137 eyes with glaucoma, 54 eyes were focal disc type, 34 eyes were myopic disc type, 28 eyes were generalized enlargement disc type and 21 eyes were senile sclerotic disc type. The myopic disc group showed a noticeable difference compared to the other groups in terms of a higher percentage of BM defect type, the lowest retinal slope (70.6 +/- 12.0degrees) and the earlier termination of retinal layers. The generalized enlargement disc group showed the highest percentage of curved BM type. Retinal slope angle increased with age and decreased with axial length. CONCLUSIONS: In the beta-zone of peripapillary atrophy, there were several differences in the shape of Bruch's membrane, composition of retinal layers and the retinal slope according to the optic disc shape.
Atrophy* ; Bruch Membrane ; Glaucoma ; Head ; Humans ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence