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Research Letter |

Elemental Composition of Ora Serrata Pearls—A Form of Focal Nodular Drusen

Lauren Wright, MD1,2; Ralph E. Eagle Jr, MD3; Jerrold L. Abraham, MD4; Ann E. Barker-Griffith, MD, FRCSC1,4
[+] Author Affiliations
1Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse
2Department of Ophthalmology, University of Texas Health Science Center at San Antonio
3Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
4Department of Pathology, State University of New York Upstate Medical University, Syracuse
JAMA Ophthalmol. 2016;134(5):601-603. doi:10.1001/jamaophthalmol.2016.0327.
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In this study, scanning electron microscopy with energy dispersive x-ray spectroscopy was applied in conjunction with classical histochemical staining techniques to characterize the elemental content of ora serrata pearls.

Examination of the peripheral fundus may reveal discrete pearl-like structures at the furthest extent of the retina. They occur throughout the ora serrata region, but only where a tongue of retina tissue in the form of a dentate process overlies the pars plana. In the later stages, the pigment epithelial covering is lost, exposing the pearl as a glistening bead. To our knowledge, the clinical significance and precise composition of these structures have not been described, although there is suggestion that they consist of drusenlike material. In this study, scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM-EDS) was applied in conjunction with classic histochemical staining techniques to characterize the elemental content of these pearls.

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Figure 1.
Ora Serrata Pearls

Examination: A, Two pearls (50 and 10 μm) at base of dentate processes. B, Detail shows pearl partially covered by retinal pigment epithelium. Photomicrographs: C, Calcified pearl (fractured during microtomy) (hematoxylin-eosin). D, Pearl without attachment to the Bruch membrane, still partially covered by retinal pigment epitheliumand retinal tuft (hematoxylin-eosin ×400).

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Figure 2.
Scanning Electron Microscopy–Energy Dispersive X-ray Spectroscopy of an Ora Serrata Pearl

Scanning electron microscopy (backscattered electron image) of pearl at low power (A) and high power (B). C, X-ray spectrum shows peaks for calcium and phosphorus, consistent with calcium phosphate.

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