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Acta Ophthalmol. 2017 Feb;95(1):e22-e28. doi: 10.1111/aos.13188. Epub 2016 Aug 22.

Retinal pigment epithelium cell density in relationship to axial length in human eyes.

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Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.



To assess associations between axial length and density of retinal pigment epithelium (RPE) cells in various ocular regions.


The histomorphometric investigation included histological sections of enucleated eyes of Caucasian patients. Using a light microscope, we counted the number of RPE cells on Bruch's membrane at the ora serrata, in the pre-equatorial region, the equatorial and retro-equatorial region, at the midpoint equator/posterior pole, and at the posterior pole.


The study included 65 globes with a mean axial length 25.9 ± 3.5 mm (range: 21.0-34.0 mm). Retinal pigment epithelium (RPE) cell count in the equatorial to retro-equatorial region (p < 0.001; correlation coefficient r2 : 0.44), in the pre-equatorial region (p < 0.001; r2 : 0.39) and at the midpoint equator/posterior pole (p = 0.03; r2 : 0.12) decreased with increasing axial length. Retinal pigment epithelium (RPE) cell count at the ora serrata (p = 0.49) and posterior pole (p = 0.44) was not significantly correlated with axial length. As a corollary, mean RPE cell density was higher (p < 0.001) at the posterior pole than at the midpoint equator/posterior pole or at the ora serrata region, where it was higher than in pre-equatorial region (p < 0.001) and in the equatorial to retro-equatorial region (p < 0.001).


The decrease in the RPE cell density mainly in the equatorial to retro-equatorial region in association with longer axial length suggests a region of enlargement of Bruch's membrane in the equatorial to retro-equatorial area in association with axial elongation. The finding may be of interest to elucidate the process of emmetropization/myopization.


axial length; emmetropization; myopia; myopization; retinal pigment epithelium

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