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. Author manuscript; available in PMC: 2021 Mar 1.
Published in final edited form as: Ophthalmology. 2019 Sep 30;127(3):394–409. doi: 10.1016/j.ophtha.2019.09.035

Figure 6: Descent of the external limiting membrane (ELM) towards Bruch’s membrane.

Figure 6:

The histology supports the clinical imaging in Figure 2,3, bottom row. The ELM descends in two curved lines on either side of a narrow isthmus of atrophy typically seen in iRORA. The ONL, HFL, OPL, and INL subside in parallel to the ELM, creating a funnel. The ONL is discontinuous, and the HFL is disordered. Where these ELM descents curve, surviving cone photoreceptors lack outer segments and have short inner segments. Layers: ELM, external limiting membrane (green arrowheads); ILM, inner limiting membrane; NFL, nerve fiber layer; GCL, ganglion cell layer; IPL, inner plexiform layer; INL, inner nuclear layer; OPL, outer plexiform layer; HFL, Henle fiber layer; ONL, outer nuclear layer; ChC, choriocapillaris; black arrowheads, Bruch’s Membrane. 87-year-old white male donor. Prepared by M. Li MD PhD and J.D. Messinger DC from the Project MACULA AMD histopathology resource: http://projectmacula.cis.uab.edu/