Abstract:Purpose
To compare the peripapillary polar characteristics in eyes combining peripapillary staphyloma and gamma peripapillary atrophy according to whether peripapillary intrachoroidal cavitation (PICC) was present or absent (combination-group).
Patients and methods
This prospective non-interventional cross-sectional study included 667 eyes of 334 subjects. From the polar peripapillary regions to the opening of Bruch’s membrane, the following elements and their topograph… Show more
“…Recently, it has been suggested that the traction on the sclera by ON sheaths not long enough 39–41 to allow a full adduction may be responsible for the outward deformation of the eye leading the sclera to detach from the underlying choroid in a PICC. 13 , 68 The same mechanism has been suggested for the occurrence of a PPS 13 in which the direct posterior component of the tensile force exerted by the scleral insertion of the ON sheaths would lead to the outpouching of the sclera 13 while the thinning of the choroid at the edge of the PPS would result from the squeezing of the choroid by the tangential component of this traction ( Figure 7 ). Above all, as at the edge of any type of PS, OCT consistently shows a choroidal thinning, the question arises of the cause of this aspect in the other types of PS.…”
“… 61 , 62 Recently, Ehongo et al discovered that this complication was not found in eyes with PPS in the absence of myopic conus while it was found in 22.7% of eyes combining these entities 60 ( Figure 6 ). This co-occurrence would result from common pathogenetic factors 13 including the ON sheaths traction force ( Figure 7 ). Figure 6 Peripapillary intrachoroidal cavitation.…”
Section: Clinical Significance Of Posterior Staphylomasmentioning
confidence: 99%
“…Although the pathogenesis of PS is currently unclear, it has recently been suggested that peripapillary staphyloma (PPS), classified as PS type III, 12 is promoted by the pulling force of the optic nerve (ON) sheaths on their scleral insertions. 13 It has even been shown that the amplitude of the forces deployed by these sheaths reaches that of the extraocular muscles. 14 The concept of deformation of the eyeball by traction or compression exerted by structures inserting on its surface is attractive and may constitute an advance in understanding the pathogenesis of other types of PS.…”
Posterior staphyloma (PS) is considered the hallmark of pathologic myopia and is defined as an outpouching of a circumscribed portion of the eyeball with a radius of curvature smaller than that of the adjacent zone. Although more common in eyes with high myopia, it can affect those without it. The presence of PS is associated with a structurally and functionally worse course of high myopia that can lead to visual disability. Unfortunately, the pathogenesis of PS is unclear so far. Thus, due to the increasing prevalence of myopia which has been further exacerbated by the advent of COVID-19 lockdown, researchers are eager to elucidate the pathogenesis of pathologic myopia and that of its complications, especially PS, which will allow the development of preventive strategies. The aim of this work was to review the morphological characteristics of PS with emphasis on similarities with peripapillary staphyloma and to discuss the pathogenesis of PS considering recent suggestions about that of peripapillary staphyloma.
“…Recently, it has been suggested that the traction on the sclera by ON sheaths not long enough 39–41 to allow a full adduction may be responsible for the outward deformation of the eye leading the sclera to detach from the underlying choroid in a PICC. 13 , 68 The same mechanism has been suggested for the occurrence of a PPS 13 in which the direct posterior component of the tensile force exerted by the scleral insertion of the ON sheaths would lead to the outpouching of the sclera 13 while the thinning of the choroid at the edge of the PPS would result from the squeezing of the choroid by the tangential component of this traction ( Figure 7 ). Above all, as at the edge of any type of PS, OCT consistently shows a choroidal thinning, the question arises of the cause of this aspect in the other types of PS.…”
“… 61 , 62 Recently, Ehongo et al discovered that this complication was not found in eyes with PPS in the absence of myopic conus while it was found in 22.7% of eyes combining these entities 60 ( Figure 6 ). This co-occurrence would result from common pathogenetic factors 13 including the ON sheaths traction force ( Figure 7 ). Figure 6 Peripapillary intrachoroidal cavitation.…”
Section: Clinical Significance Of Posterior Staphylomasmentioning
confidence: 99%
“…Although the pathogenesis of PS is currently unclear, it has recently been suggested that peripapillary staphyloma (PPS), classified as PS type III, 12 is promoted by the pulling force of the optic nerve (ON) sheaths on their scleral insertions. 13 It has even been shown that the amplitude of the forces deployed by these sheaths reaches that of the extraocular muscles. 14 The concept of deformation of the eyeball by traction or compression exerted by structures inserting on its surface is attractive and may constitute an advance in understanding the pathogenesis of other types of PS.…”
Posterior staphyloma (PS) is considered the hallmark of pathologic myopia and is defined as an outpouching of a circumscribed portion of the eyeball with a radius of curvature smaller than that of the adjacent zone. Although more common in eyes with high myopia, it can affect those without it. The presence of PS is associated with a structurally and functionally worse course of high myopia that can lead to visual disability. Unfortunately, the pathogenesis of PS is unclear so far. Thus, due to the increasing prevalence of myopia which has been further exacerbated by the advent of COVID-19 lockdown, researchers are eager to elucidate the pathogenesis of pathologic myopia and that of its complications, especially PS, which will allow the development of preventive strategies. The aim of this work was to review the morphological characteristics of PS with emphasis on similarities with peripapillary staphyloma and to discuss the pathogenesis of PS considering recent suggestions about that of peripapillary staphyloma.
“…Ehongo et al described a shared anteroposterior alignment among expanded subarachnoid space (SAS), exclusive staphyloma-related choroidal excavation (SCD), and the wedge configuration of the posterior choroidal wall, along with the discontinuity of the embedded ONH border tissue and additional choroidal thickness coinciding with dural traction. They hypothesized that PICC is actually a type of suprachoroidal detachment, following the collapse of the scleral flange caused by the tensile forces of the optic nerve sheaths during adduction ( 52 ). Based on SS-OCT, Xie et al assessed the correspondence between structural characteristics and VF defects, highlighting that instead of the presence of PICC itself, herniation and eventual loss of local retinal tissue may be the true reason behind VF defects ( 30 ).…”
Highly myopic optic nerve head (ONH) abnormalities encompass a series of complications resulting from the stretching of papillary and peripapillary structures during significant axial elongation. The morphological changes in the ONH typically initiate with disk tilting or rotation, progressing to PHOMS and PPA. Tissue defects in each layer manifest as focal lamina cribrosa defects (FLDs), peripapillary intrachoroidal cavitations (PICCs), and acquired pits of the optic nerve (APON). Anterior vitreous/vascular traction and posterior scleral protrusion may lead to prelaminar schisis as well as paravascular cysts and holes, which can potentially develop into retinoschisis. Traditional color fundus photography (CFP) is often insufficient for visualizing most of these lesions, yet their description and quantification benefit significantly from the advancements in optical coherence tomography (OCT) and OCT angiography (OCTA), complemented by fundus autofluorescence (FAF), indocyanine green angiography (ICGA), and three-dimensional imaging. The effective diagnosis and classification of ONH abnormalities heavily rely on a comprehensive understanding of their multimodal imaging features, as outlined in this review. These findings provide valuable insights into optic neuropathy in high myopia, establishing a solid foundation for future endeavors in disease monitoring and treatment guidance.
“…Later, Spaide et al described the PICC as a suprachoroidal separation using SS-OCT [ 38 ]. Recently, Ehongo et al, also based on SS-OCT findings, suggested that the tensile forces of the optic nerve sheaths during adduction cause the collapse of the scleral flange onto the subarachnoid space, leading to PICC [ 39 ]. In OCT images, PICC is indeed defined as a hyporeflective triangular thickening of the choroid with the base at the optic disc border ( Figure 3 A), excluding the peripapillary large choroidal vessels.…”
Glaucoma diagnosis in highly myopic subjects by optic nerve head (ONH) imaging is challenging as it is difficult to distinguish structural defects related to glaucoma from myopia-related defects in these subjects. Optical coherence tomography (OCT) has evolved to become a routine examination at present, providing key information in the assessment of glaucoma based on the study of the ONH. However, the correct segmentation and interpretation of the ONH data employing OCT is still a challenge in highly myopic patients. High-resolution OCT images can help qualitatively and quantitatively describe the structural characteristics and anatomical changes in highly myopic subjects with and without glaucoma. The ONH and peripapillary area can be analyzed to measure the myopic atrophic-related zone, the existence of intrachoroidal cavitation, staphyloma, and ONH pits by OCT. Similarly, the lamina cribosa observed in the OCT images may reveal anatomical changes that justify visual defects. Several quantitative parameters of the ONH obtained from OCT images were proposed to predict the progression of visual defects in glaucoma subjects. Additionally, OCT images help identify factors that may negatively influence the measurement of the retinal nerve fiber layer (RNFL) and provide better analysis using new parameters, such as Bruch’s Membrane Opening-Minimum Rim Width, which serves as an alternative to RNFL measurements in highly myopic subjects due to its superior diagnostic ability.
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