Senile macular degeneration. Clinicopathologic correlations of a case in the predisciform stage

A 66-year-old man had lesions in the maculas of both eyes which were considered, on the basis of ophthalmoscopic examination and fluorescein angiography, to represent multiple, confluent drusen. The fundus appearance did not change over two years, although visual acuity decreased by three to four lines. Following death, segments of each globe containing the maculas and optic nerves were serially sectioned and these portions of the fundi were reconstructed to scale, using graph paper and a microscope equipped with an ocular micrometer. No drusen were found in either macula, and changes in the pigment epithelium and choriocapillaris were minimal. Large serous detachments of the neurosensory and pigment epithelium were present in each eye but did not correspond in location to the lesions observed during life; nor were such detachments seen during life when the fundus was examined with the slit lamp and contact lens. These detachments may represent an agonal change. We conclude that the drusen-like lesions often seen clinically in the predisciform stage of senile macular degeneration are not always true drusen, although their precise nature was not evident from our study. Reconstruction of the fundus to scale from serial microscopic sections is a useful way to correlate clinically observed abnormalities with lesions seen histopathologically.