Focal occlusion of the choriocapillaris can lead to loss of the outer retinal layers and RPE, a condition known as paving-stone or cobblestone degeneration. This type of atrophy is common in the retinal periphery in older individuals. The well-demarcated, flat, pale lesions seen clinically correspond to circumscribed areas of outer retinal and RPE atrophy and loss of the choriocapillaris, with adherence of the INL to Bruch membrane (Fig 11-14). Histologically, these findings are similar to those found in geographic atrophy in age-related macular degeneration.
Figure 11-13 Long-standing total retinal detachment with macrocystic degeneration of the retina.
Figure 11-14 Paving-stone degeneration. A, Photograph shows the gross appearance of paving-stone degeneration: areas of depigmentation (arrows) in the peripheral retina near the ora serrata. B, Histologically, paving-stone degeneration shows atrophy of the outer retinal layers and adhesion of the remaining inner retinal elements to Bruch membrane. The sharp boundary (arrowheads) between the normal and the atrophic retina corresponds to the clinical appearance of paving-stone degeneration.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.