Histologic and Morphometric Comparison of Drusen Associated With Chronic Retinal Detachment and Aging-Associated Drusen

Purpose: Drusen are subretinal pigment epithelium extracellular matrix deposits. This study compared histomorphometric characteristics of age-related and atypical drusen found in an eye of a young woman with chronic retinal detachment (RD). Methods: We conducted a histomorphometric examination of drusen identified in 3 eyes: an eviscerated eye from a 35-year-old woman with chronic RD, and 2 specimens of 2 patients, aged 91 and 77 years, with typical age-related drusen. Sections of formalin-fixed tissue stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), Masson trichrome, luxol fast blue (LFB), and Von Kossa were evaluated using light microscopy. Drusen dimensions were quantified using Philips Digital Pathology Software. Results: Atypical drusen identified in the RD eye (n = 25) displayed spheroidal shape with peripherally radiating fibrils. There were foci of dystrophic calcification and localized chronic choroidal inflammation and within some drusen. Age-related drusen (n = 29) had a typical dome-shaped appearance. Atypical drusen had significantly larger (P < 0.001) average circumference (278 vs. 52 µm), diameter (96 vs. 20 µm), and area (0.006 vs. 0.00022 mm2) than age-related drusen, respectively. Both groups stained positively with PAS, negatively with LFB and Von Kossa, and blue on Masson Trichrome. Conclusions: Atypical drusen found in this RD case display significant differences in morphometric parameters compared to age-related drusen but similar histochemical staining patterns, suggesting a similar macromolecular composition. Further investigations are needed to inform drusen pathogenesis, morphology, and associations with sex, age, or long-standing RD. Translational Relevance: This case adds to the limited body of evidence on drusen in younger patients and suggests that atypical drusen may form in association with RD.