Cuticular Drusen - Fluorescein Angiogram

Basal laminar drusen, also called curticular drusen, present a starry sky appearance on fluorescein angiography. A typical example is shown in this example. On an ultrastructural level, the composition of all drusen is the same. They contain lipid waste derived primarily from cholesterol together with many types of protein. These deposits lie between the basement membrane of the retinal pigment epithelium and the inner collagenous layer of Bruch's membrane. That is, drusen are found beneath the retinal pigment epithelium. No one knows why the morphologies of cuticular drusen and the more common soft drusen of age related macular degeneration are different, but the composition is so similar.