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

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 choriocapillaris 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 prognostic implications, photocoagulation has been advocated when new vessels can be demonstrated by fluorescein angiography in inflammatory or degenerative conditions. Once the retina is elevated by exudate, haemorrhage, or fibrovascular tissue, new vessels can be identified in a high proportion of cases (Teeters and Bird, I 973a). However, the frequency with which new vessels precede these complications is not known. Moreover, the fundus details corresponding to clinically unsuspected subretinal neovascularization have not been fully described. The purpose of this investigation was to determine the frequency with which new vessel formation beneath the retina can be demonstrated histologically in senile eyes and to describe the associated clinical and histological findings.