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. 2023 Jan 25;9(2):e13257.
doi: 10.1016/j.heliyon.2023.e13257. eCollection 2023 Feb.

Myopic macular Bruch's membrane defects

Songhomitra Panda-Jonas  1   2 , Gerd U Auffarth  1 , Jost B Jonas  1   3   4 , Rahul A Jonas  5
Affiliations

Myopic macular Bruch's membrane defects

Songhomitra Panda-Jonas et al. Heliyon. .

Abstract

Purpose: To examine histologic characteristics of macular Bruchś membrane defects (BMD) in axially elongated eyes.

Design: Histomorphometric study.

Methods: Using light microscopy, we examined enucleated human globes for BMDs.

Results: In 247 eyes, BMDs were detected in 15 (6.1%) eyes (axial length:27.0-36.0 mm), in 10 of them in the macular region. Prevalence and size of BMDs (mean:1.93 ± 1.62 mm; range:0.22mm-6.24 mm) correlated with longer axial length (OR:1.52; 95%CI:1.19,1.94; P = 0.001) and higher prevalence of scleral staphylomas (OR:16.3; 95%CI:2.67,99.3; P < 0.001). The BMDs were smaller than corresponding gaps in the retinal pigment epithelium (RPE) (1.93 ± 1.62 mm versus 2.61 mm ± 1.73 mm; P = 0.003), and larger than corresponding gaps in the inner nuclear layer (0.43 ± 0.76 mm; P = 0.008) and inner limiting membrane bridges (0.13 ± 0.33 mm; P = 0.001). Choriocapillaris thickness, BM thickness and RPE cell density did not vary (all P > 0.05) between the BDM border and adjacent areas. In the BMD, choriocapillaris and RPE were absent. The sclera was thinner in the BDM area than in adjacent areas (0.28 ± 0.19 mm versus 0.36 ± 0.13 mm; P = 0.006).

Conclusions: BMDs as hallmarks of myopic macular degeneration are characterized by longer gaps in the RPE and smaller gaps in the outer nuclear layer and inner nuclear layer, by localized scleral thinning, and by a spatial association with scleral staphylomas. Thickness of the choriocapillaris and density of the RPE cell layer, both absent within the BDMs, do not vary between the BMD border and adjacent regions. The results suggest an association between BDMs and absolute scotomas, stretching of the adjacent retinal nerve fiver layer, and an axial elongation-associated stretching effect on BM as etiology of the BDMs.

Keywords: Axial myopia; Bruch’s membrane; Bruch’s membrane defects; Myopia; Myopic macular degeneration; Myopic maculopathy.

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Figures

Fig. 1
Fig. 1
Microphotograph showing a Bruch’s membrane defect, surrounded by a larger defect in the retinal pigment epithelium layer, and capped by a smaller defect in the outer nuclear layer. The inner nuclear layer, the retinal nerve fiber layer and the inner limiting membrane are intact in the region of the Bruch’s membrane defect.
Fig. 2
Fig. 2
(a) Microphotograph showing Bruch’s membrane island, surrounded by Bruch’s membrane defects. In the defect, the outer nuclear layer is missing, the retina pigment epithelium and the choroid are missing, while the inner nuclear layer, the retinal nerve fiber layer and the inner limiting membrane are present in the region of the Bruch’s membrane defect. (b)Microphotograph (higher magnification of Fig. 2a) showing at the margin of the Bruch’s membrane defect the end of Bruch’s membrane (black arrow) and the end of the outer nuclear layer (yellow arrow).
Fig. 3
Fig. 3
(a) Microphotograph showing a Bruchś membrane defect (red arrow). (b) Microphotograph (higher magnification of Fig. 3a#) showing at both margins of the Bruch’s membrane defect the ends of Bruch’s membrane (red arrows) and the end of the outer nuclear layer. The defect is covered by inner retinal layers and the inner limiting mmebrane.
See this image and copyright information in PMC

References

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