ANATOMY of Retina, Bruch

Membrane, Ora Serrata, &

Vitreous
Dhita Dewi Alviane, dr.
 Contents
• Retina • Bruch Membrane
• Neurosensory Retina • Ora Serrata
• Neuronal Elements
• Glial Elements • Vitreous
• Vascular Element
• Stratification of the neurosensory
retina
• Topography of the Retina
• Macula
• Fovea
• Retinal Pigment Epithelium (RPE)
Retina
 Retina

Retina : thin and delicate membrane, innermost layer Retina divided into 2 parts :
of the eyeball. Neurosensory & Retinal Pigmented Epithelium
Retina
• Fundus oculi (terlihat melalui
ophthalmoscopy) : retina, pembuluh
darah, dan optic nerve (optic disc –
blind spot)
• Terlihat kemerahan  transmisi
cahaya yang terpantul dari posterior
sclera melalui choroidal capillary bed
• Macula : antara susunan vascular
bagian temporal
• Fovea : di tengah2 macula. Thinnest
area of retina. Shapest vis. aquity.
avascular
• Foveola : ditengah2 fovea (Fig 2.31)
Retina - Neurosensory Retina
• Neurosensory Retina : tipis,
transparan, berkembang dari
inner layer optic cup
(embriologically). Meanwhile,
RPE berkembang dari outer layer
optic cup.
• Terdiri dari : neuronal, glial
(sama spt sel2 di CNS), dan
vascular elements (Figs 2-33, 2-
34)
Retina - Neurosensory Retina
• In cross section, dari dalam keluar retina,
area lapisan neurosensory retina ialah
(Fig 2-32):

• internal limiting membrane

• nerve fiber layer
• ganglion cell layer
• inner plexiform layer
• inner nuclear layer
• middle limiting membrane
• outer plexiform layer (referred to as Henle
fiber layer in the foveal region)
• outer nuclear layer
• external limiting membrane
• rod and cone inner segments
• rod and cone outer segments
Retina - Neurosensory Retina
Retina - Neurosensory Retina
• Neuronal Elements
• Photoreceptor layer of neurosensory
retina terdiri dari sel neuroepithelial
yg sangat terspesialisasi  rods dan
cones
• Terdapat +/- 100-125 juta rods, 6-7
juta cones dalam retina manusia.
Rasio +/- 20 : 1
• Tiap sel fotoreseptor terdiri dari outer
segment dan inner segment
• Outer segment : terselimuti dengan
mucopolysaccharide matrix,
bersinggungan dgn tonjolan apical
RPE. Tdk ada tight junction/ koneksi
interselular yg menghubungkan
keduanya (krna berasal dari sumber
embriologi yg sama – optic cup). Tp
keduanya tetap berdekatan
sehubungan dgn kepentingan active
transport ( vander Waals forces,
oncotic pressure, electrostatic forces)
• Clinical significance : retinal
detachment  neuronal layer detach
from RPE
Retina - Neurosensory Retina
Retina - Neurosensory Retina
• Neuronal Elements
• Rod photoreceptor
• Outer segment : contains multiple
laminated discs resembling a stack of
coins and a central connecting cilium
(Fig 2-33).
• Inner segment subdivided into 2
additional elements  outer ellipsoid
(containing numerous mitochondria),
and an inner myoid (containing a large
amount of glycogen)
• the myoid is continuous with the main
cell body, where the nucleus is located.
• The inner portion of the cell contains
the synaptic body, or spherule (single
invagination, accommodates 2
horizontal cell & 1 or more bipolar
dendrit)
 Retina - Neurosensory Retina
• Neuronal Elements
• Cone photoreceptor
• Outer segment - different
morphology depending on their
location in the retina. structure of
the outer segments of the rods and
cones is similar, but rod disc – not
attached to the cell membrane
(discrete structure). Cone disc –
attached to cell membrane. (Fig 2-
33)
• Inner segment – synaptic body
(pedicle) is more complex than the
rod spherule (Fig 2-34)
 Retina - Neurosensory Retina
• Neuronal Elements
• Horizontal cells : make synaptic
connections with many rod spherules and
cone pedicles; they also extend cell pr
cesses horizontally throughout the outer
plexiform layer
• Bipolar cells : oriented vertically. Their
dendrites synapse with rod or cone synaptic
bodies, and their axons make synaptic
contact with ganglion cells and amacrine
cells in the inner plexiform layer.
• Axons of the ganglion cells : bend to
become parallel to the inner surface of the
retina, where they form the nerve fiber
layer and later the axons of the optic nerve
Retina - Neurosensory Retina
• Glial Elements  Muller Cells
• glial cells, extend vertically from
ext limiting membrane to int
limiting membrane.
• Nuclei are located in inner nuclear
layer
• provide structural support and
nutrition to the retina and are
crucial to normal physiology. (the
fibrous and protoplasmic
astrocytes and microglia)
• int limiting membrane contribute
to the inner blood–retina barrier.
Retina - Neurosensory Retina
• Vascular Elements
• The retina is a highly metabolic
structure, with the highest rate of
oxygen consumption per unit weight
in the body
• Retinal B.vessel analogous to cerebral
b.vessel (maintain inner blood-retina
barrier) due to non fenestrated
single layer endhothelial cells.
Surrounded by by pericytes, or mural
cells, which suppress endothelial
proliferation and, along with glial
cells, contribute to the inner blood–
retina barrier
• Muller cells and other glial ele ments
are generally attached to the basal
lamina of retinal blood vessels.
Retina - Neurosensory Retina
• The retina possesses a dual
circulation :
• Inner layer retina  supplied by
branches of the central retinal
artery
• Outer layer retina  perfused by
the choroid (see Fig 2-32).
Retina - Neurosensory Retina
• Stratification of the neurosensory retina
Retina – Topography of Retina
• Retinal thickness variations (Figs 2-41,
2-42).
• Thickest in the papillomacular bundle
near the optic nerve (0.23 mm)
• Thinnest in the foveolar (0.10 mm) and
ora serrata (0.11 mm).
Retina – Topography of Retina
• Macula
• Diameter : 5-6 mm, located in the
area between the temporal
vascular arcades
• Histologically, it is the region with
more than 1 layer of ganglion cell
nuclei
• Named Macula lutea (means
yellow spot) : the yellow color of
the central retina in dissected
cadaver eyes (due to the presence
of carotenoid pigments). Primarily
located in the Henle fiber layer
Retina – Topography of Retina
• Two major pigments— zeaxanthin
and lutein— have been identified
whose proportions vary with their
distance from the fovea.
• Central area (0.25 mm from the
fovea), the lutein- to- zeaxanthin ratio
is 1:2.4, and in the periphery (2.2–8.7
mm from the fovea), the ratio is
greater than 2:1.
• This variation in pigment ratio
corresponds to the rod- to- cone
ratio.
• Lutein is more concentrated in rod-
dense areas of the retina
• Zeaxanthin is more concentrated in
cone- dense areas.
Retina – Topography of Retina
• Fovea
• Specialized portion of the macula that
appears as a central retinal depression.
• Diameter +/- 1.5 mm
• Inexact margin
• Foveola
• a central depression in the floor of the fovea
• Location : +/- 4.0 mm temporal, 0.8 mm
inferior to the center of the optic nerve head.
• Diameter : +/- 0.35 and 0.10 mm thick at its
center.
• Usually, only photoreceptors, Muller cells,
and other glial cells are present in this area.
• The location of the foveal avascular zone
(FAZ), or capillary- free zone (Fig 2-44; see
also Fig 2-39), is approximately the same as
that of the foveola
 Retina – Retinal Pigment Epithelium
• RPE berkembang dari outer layer
of optic cup
• Terdiri atas monolayer
hexagonal cells, memanjang
kedepan dari head of optic nerve
hingga ora serrata, kemudian
bergabung dengan pigmented
epithel dari ciliary body.
 Retina – Retinal Pigment Epithelium
• Fungsi RPE :
• vitamin A metabolism
• maintenance of the outer blood– ocular
barrier
• phagocytosis of the photoreceptor outer
segments
• absorption of light (reduction of scatter)
• formation of the basal lamina of the Bruch
membrane
• production of the mucopolysaccharide
matrix surrounding the outer segments
• maintenance of retinal adhesion
• active transport of materials into and out
of the RPE
• RPE cells are polarized (memiliki
kutub)
• Basal : melipat2 secara kompleks,
menyediakan permukaan besar untuk
menempel ke basal lamina yg tipis
 membentuk inner layer of the
Bruch membrane.
• Apikal : banyak tonjolan villi 
envelop and engage with the
photoreceptor outer segments (Fig 2-
45)
• Separation of the RPE from the
neurosensory retina is called
retinal detachment.
Retina – Retinal Pigment Epithelium
Retina – Retinal Pigment Epithelium
• Contiguous RPE cells  firmly
attached by a series of lateral
junctional complexes.
• The zonulae occludentes and
zonulae adherentes not only
provide structural stability but also
play an important role in
maintaining the outer blood–
ocular barrier (see Fig 2-45).
• RPE cell diameter : 10–14 μm in the
macula to 60 μm in the periphery.
• compared with RPE cells in the
periphery, RPE cells in the fovea are
taller and thinner, contain more
melanosomes, and have larger
melanosomes (account in part for the
decreased transmission of choroidal
fluorescence observed during fundus
fluorescein angiography)
• The cytoplasm of the RPE cells
contains multiple round and ovoid
pigment granules (melanosomes).
(see Fig 2-45).
Retina – Retinal Pigment Epithelium
• RPE cell diameter : 10–14 μm in the
macula to 60 μm in the periphery.
• compared with RPE cells in the periphery,
RPE cells in the fovea are taller and
thinner, contain more melanosomes, and
have larger melanosomes (account in part
for the decreased transmission of choroidal
fluorescence observed during fundus
fluorescein angiography)

• The cytoplasm of the RPE cells contains :

• multiple round and ovoid pigment granules
(melanosomes)
• numerous mitochondria (which are
involved in aerobic metabolism), rough-
surfaced endoplasmic reticulum, a Golgi
apparatus, and a large round nucleus
Retina – Retinal Pigment Epithelium
• Lipofuscin granules
• arise from the discs of
photoreceptor outer segments
• represent residual bodies from
phagosomal activity.
• Phagosomes
• phagocytic function  they
continually ingest the disc
membranes shed by the outer
segments of photoreceptor cells,
enclosing them within
phagosomes.
Retina – Retinal Pigment Epithelium
Bruch Membrane
 Bruch Membrane
• Bruch Membrane :
• PAS-positive lamina (membrane),
fusion of basal laminae of RPE and
choriocapillaries of the choroid.
(Fig 2-46)
• Extends from margin of the nerve
head to the ora serrata.
• Highly permeable to small
molecules such as fluorescein
Bruch Membrane
• Defects in the membrane may
develop in myopia, pseudoxanthoma
elasticum, trauma, or inflammatory
conditions and may, in turn, lead to
the development of choroidal
neovascularization.
• Consist of 5 elements :
• basal lamina of the RPE
• inner collagenous zone
• relatively thick, porous band of
elastic fibers
• outer collagenous zone
• basal lamina of the choriocapillaris
• With age, debris accumulates in and
thickens the Bruch membrane.
Bruch Membrane
Ora Serrata
 Ora Serrata
• The ora serrata separates the
retina from the pars plana (Fig 2-
47).
• Its distance from the Schwalbe
line is between 5.75 mm nasally
and 6.50 mm temporally.
• In myopia, this distance is
greater; in hyperopia, it is
shorter.
 Ora Serrata
Externally, the ora serrata lies beneath the
spiral of Tillaux

External view (Right globe)

Ora Serrata
• At the ora serrata, the diameter of
the eye is 20 mm and the
circumference is 63 mm
• At the equator, the diameter is 24
mm and the circumference is 75
mm.
• Topographically, the margin of the
ora serrata is relatively smooth
temporally and serrated nasally.
• Retinal blood vessels end in loops
before reaching the ora serrata.
Vitreous
 Vitreous
• Viteous cavity: 4/5 volume of globe
• Transparent, important to the
metabolism of the intraocular
tissues, bcs provides a route for
metabolites used by the lens,
ciliary body, and retina.
• Gel-like structure, but 99% water.
• Viscosity got from
mucopolysaccharide hyaluronic
acid. (2x viscose than water)
 Vitreous
• Ultrastructure : fine collagen fibrils
(chiefly type II) and cells
(hyalocytes).
• The origin and function of these cells,
termed hyalocytes, are unknown, but
they probably represent modified
histiocytes, glial cells, or fibroblasts.
• The fibrils at the vitreous base
merge with the basal lamina of the
nonpigmented epithelium of the
pars plana and, posteriorly, with
the ILM of the ret ina, the
vitreoretinal interface
Vitreous
• The vitreous adheres to the retina
peripherally at the vitreous base
(Fig 2-50), which extends from 2.0
mm anterior to the ora serrata to
approximately 4.0 mm posterior to
it.
• Additional attachments exist at the
optic nerve head margin, at the
perimacular region surrounding the
fovea, along the ret i nal vessels,
and at the periphery of the
posterior lens
• capsule (Fig 2-51)