New vessel formation beneath the retinal pigment epithelium in senile eyes.

Abstract

Verhoeff and Grossman (1937) originally demonstrated that haemorrhage may occur beneath the retinal pigment epithelium and undergo organization to produce the picture of senile disciform degeneration. The haemorrhage has generally been thought to arise from a diseased choriocapillaris, especially as clinical evidence of senile macular degeneration frequently precedes this complication (Maumenee, I965). Gass (I967) further developed this concept of a predisciform stage in which senile alterations in the chorio- capillaris and Bruch's membrane were associated with eosinophilic material beneath the retinal pigment epithelium. He was able to demonstrate subretinal neovascularization in four such eyes and suggested that haemorrhage or exudation may arise from vessels already established on the inner surface of Bruch's membrane. In view of these prog- nostic implications, photocoagulation has been advocated when new vessels can be demon- strated by fluorescein angiography in inflammatory or degenerative conditions.