How is paving stone like degeneration differentially diagnosed?

  1, Genetic examination.  2.Histopathology: Degenerative myopic eye grows and enlarges, lesions are mainly in the equatorial part especially in the posterior pole, the sclera thins and forms scleral chylomalacia in the posterior pole. The choroid thins, the stromal pigment is lost, the number of vessels decreases, and small vessels and capillaries disappear. the Bruch’s membrane thins and can rupture. Significant atrophy of the ciliary body, mainly due to hypoplasia of the annular muscle fibers. The choroidal retina is atrophied and the RPE in the atrophic area disappears completely. the RPE proliferates significantly to form Fuchs, which is covered with a gelatinous, cell-free exudate.  3, Fundus fluorescence angiography: In mild diffuse lesions, the posterior pole of the arterial phase has dotted or linear spots in the shape of paint cracks. With the extension of time and enhanced brightness, but does not expand, the background fluorescence disappears after a long time, severe lesions with atrophic plaques in the posterior pole, the imaging shows that the arterial phase has extensive dotted, linear or lamellar fluorescence spots or shows strong fluorescence areas and weak fluorescence areas. This indicates that the choroidal capillary layer is atrophied, and coarse choroidal vascular filling is visible.  Peripheral retinal choroidal degeneration: Myopic peripheral lesions are divided into: (1) diffuse choroidal degenerative lesions; (2) banded choroidal degenerative lesions; and (3) retinal cystoid degeneration. Other manifestations of peripheral degeneration include: ① pigment degeneration: increased pigment in the form of dots or spots. It may be associated with vitreous traction, abnormal biochemical stimulation that causes proliferation of pigment epithelial cells. It is obvious in people with long eye axis, mostly seen in people <40 years old; ② paving stone like degeneration: it is manifested as small white prolate or oval shaped choroidal retinal atrophy foci with clear borders, which may be accompanied by blocky pigment spots. The choroidal vessels are clearly visible in the lesions; ③ lattice-like degeneration; ④ non-pressure whitening; ⑤ cystic degeneration and foveal cystic degeneration. Most of the lesions have a shallow plasma detachment with strong fluorescence in angiography, sometimes accompanied by leakage in the early stage, and the lesions leave a scar after healing, and the pigment may increase with time.  Patients with high myopia need regular observation and should pay attention to eye hygiene.