The disciform response: An historical perspective

Abstract

This paper is a survey of the literature in an attempt to provide the basis for our current understanding of the disciform process. Particular emphasis is placed on its pathogenesis and the role of subretinal neovascularization. No two lesions appear exactly alike because of the many stages and combinations possible. Gass (1967) has delineated the broad spectrum with the many different clinical manifestations of this disease process. Verhoeff and Grossman (1937) provided the histopathologic basis for our understanding of the disciform process. The histologic correlation of the clinical "predisciform" state would seem to offer the most promising information for understanding the pathogenesis of the disciform process (Frank et al. 1973; Green and Key 1977; Kornweig 1967; Sarks 1973 and 1976; Small et al. 1976; Zauberman 1970). It is hoped that this literature review has sufficiently emphasized the inherent deficiencies of strictly clinical studies and the need for an appropriate experimental animal model (Ryan 1979).

Natural history of choroidal neovascularization induced by vascular endothelial growth factor in the primate

“…The histologic findings in this study are similar to those found in human CNV membranes [21,33]. We have shown that choroidal neovascularization into the subretinal space is accompanied by RPE cell proliferation within the developing membranes in close association with endothelial cells.…”

“…Choroidal neovascularization (CNV) is a common feature of many ocular disorders, including ocular histoplasmosis, angioid streaks, and myopia, and is the major cause of severe visual loss in patients with age-related macular degeneration [7, 14,29,33]. The newly formed vessels originate from the choroid and enter the subretinal space, where they are recognized clinically by fluorescein leakage during angiography [7,40].…”

Geographic Atrophy

“…Even today, the term “Kuhnt-Junius macular degeneration” [Junius-Kuhnt Makuladegeneration] is used for disciform lesions with obvious fibrotic scar tissue. A “historical perspective” with an extensive review of the literature of “disciform macular degenerations” was published by Stephen J Ryan et al in 1980 21 .…”

“…Sorsby and Crick did not use the term “geographic” nor did they consider senile macular degeneration as an etiological possibility. The term “choroidal sclerosis” in general appears to have already been used at the time of Nettleship and Haab in the 1880s and later on as a descriptive term for the appearance of prominent white choroidal vessels in which the blood columns were not seen or were sheathed by white lines, also implying a angiosclerotic, and/or cardiovascular association for the presence of atrophy 21, 22, 24, 44 . Finally, it is important to note that Gass stressed another entity in the differential diagnosis of “central areolar pigment epithelial atrophy secondary to senile macular choroidal degeneration” in the first edition of the atlas, namely “central areolar choroidal sclerosis” as part of a spectrum of “non-exudative heredodegenerative diseases of the choroid” 42 .…”

A case of macular subretinal neovascularisation in chronic uveitis probably caused by sarcoidosis.

“…For -in2 this reason only local corticosteroids in combinationll 1l| @F with antiglaucoma therapy were given._ l ! Afluorescein angiogram ofg.5 the right eye (Ftig.t 6) shoednaciiyo subretinal neovascularisation a iapae.I ron ied . ctie sc seith surrounding pigment epithelium changes was visible.…”