Histological Findings in a Case of Angioid Streaks

Abstract

FOR the privilege of making'this report I am indebted to the late Dr. Grady E. Clay. It deals with the.microscopic examination of one eye removed after death from a patient with angioid streaks in both eyes. The eye was removed under the direction of Dr. Clay and sent by him to Dr. Algernon Reese-for sectioning. A complete set of celloidin sections was prepared and stained under Dr, Reese's supervision and then sent to me at the request of Dr. Clay. The hospital at which the patient died was the Grady Memorial Hospital of Atlanta, Georgia, and to the'authorities of this'institution I am indebted for complete copies of the hospital records including the autopsy report on this patient. The clinical record was signed by Guh H. Adams, M.D. The autopsy was performed by Abner Golden, M.D., and the report signed by Walter H. Sheldon, M.D., pathologist.-For the purposes of this paper the following summary of these hospital records will suffice: The patient, a 50-year-old coloured female was admitted to the Grady Memorial Hospital, Atlanta, Ga., Jan. 28, 1944. She was known to have had syphilis which was inadequately treated. However, the Kahn test was negative at the final admission to the hospital although in 1935 the Wassermann test was 4 plus. She was known to have had hypertension since 1935. In 1939 the blood pressure was recorded as 200/110 ind at this time she began to experience intermittent oedema of the ankles. lThere were not marked symptoms, however, until three 531 copyright.

Angioid streaks, clinical course, complications, and current therapeutic management

“…The prophylactic therapy of angioid streaks with laser beams in order to avoid the development of CNV has been used before,30 but it is no longer recommended and many researchers strongly believe that this kind of intervention can actually induce CNV 31…”

Macular Degeneration in Angioid Streaks

“…2). Unlike pseudoxanthoma elasticum, hemorrhagic macular degeneration seems less frequent in sickle cell disease [14,15], The exudative form is more common than the atrophic form of macular degeneration in angioid streaks in contradistinction to agerelated macular degeneration [9,16]. In the present study, the occurrence of neovascular membranes under the fovea correlated with the streak length, distance of the streak from the fovea, and with the diffuse type of angioid streak.…”

“…The breaks in Bruch's membrane widened in angioid streaks and not in agerelated macular degeneration. This was at tributed to the loss of elasticity of the aging Bruch's membrane [ 16]. This elasticity could accouni partly for the absence of choroidal membranes in many wide streaks due to the concomitant stretching of the underlying choriocapillaris [ 17], However, sclerosis of the choriocapillaris and retinal pigment epithe lium dysfunction could play a major role besides the mechanical theory of elasticity.…”

Classification of Angioid Streaks

“…Presumably the changes described by him are the earliest lesions ofangioid streaks. This degeneration leads to anatomical defects in the membrane and it becomes less translucent (Hagedoorn, 1939;Klien, 1947;Verhoeff, 1948). The gaps in the membrane show up by contrast.…”

“…His conclusions were drawn solely from clinical observation, and confirmation was not forthcoming until Bock (1938) described such lesions in microscope sections. Bock's report was soon followed by those of Hagedoorn (1939), Klien (1947), Verhoeff (1948), and Winkelman (1948. By courtesy of Sir John McNee, I was able to examine the eyes of a 59-year-old woman in his wards in the Western Infirmary, Glasgow.…”