Detection of Zinn-Haller Arterial Ring in Highly Myopic Eyes by Simultaneous Indocyanine Green Angiography and Optical Coherence Tomography

Ohno‐Matsui, Kyoko; Kasahara, Kaori; Moriyama, Muka

doi:10.1016/j.ajo.2012.12.010

Cited by 16 publications

(13 citation statements)

References 23 publications

(27 reference statements)

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“…Both studies also agree in that non-highly myopic glaucomatous eyes and non-highly myopic non-glaucomatous eyes did not differ in the location of the ZHAC. The findings of our histomorphometric study complement the recent clinical study by Ohno-Matsui and colleagues who imaged the ZHAC by indocyanine-green angiography and enhanced depth imaging of optical coherence tomography in 94 highly myopic eyes defined as an axial length of >26.5 mm or a myopic refractive error <−8 diopters [28]. Ohno-Matsui and coworkers found the ZHAC within the area of myopic conus, with the vessels appearing as a hyporeflective circle within the peripapillary sclera.…”

Section: Discussionsupporting

confidence: 83%

“…that the distance between the ZHAC and the optic disc border is markedly enlarged in highly myopic eyes. Fourth, according to a previous study, ZHAC in highly myopic eyes usually has a rhomboid shape suggesting that the distance between the ZHAC and the optic disc margin might be different between horizontal and vertical sections [28]. The majority of the globes of our study sample, in the highly myopic group as well as in the non-highly myopic group, were however, cut in a horizontal direction.…”

Section: Discussionmentioning

confidence: 77%

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Peripapillary Arterial Circle of Zinn-Haller: Location and Spatial Relationships with Myopia

2013

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PurposeTo measure histomorphometrically the location of the peripapillary arterial circle of Zinn-Haller (ZHAC) and assess its associations with axial length.MethodsUsing a light microscope, we measured the distance from the ZHAC to the peripapillary ring (optic disc border), the merging point of the dura mater with the posterior sclera (“dura-sclera point”), and the inner scleral surface. In the parapapillary region, we differentiated between beta zone (presence of Bruch's membrane, absence of retinal pigment epithelium) and gamma zone (absence of Bruch's membrane). The peripapillary scleral flange as roof of the orbital cerebrospinal fluid space was the connection between the end of the lamina cribrosa and the posterior full-thickness sclera starting at the dura-sclera point.ResultsThe study included 101 human globes (101 patients) with a mean axial length of 26.7±3.7 mm (range: 20.0–39.0 mm). The distance between the ZHAC and the peripapillary ring increased significantly with longer axial length (P<0.001; correlation coefficient r = 0.49), longer parapapillary gamma zone (P<0.001;r = 0.85), longer (P<0.001;r = 0.73) and thinner (P<0.001;r = −0.45) peripapillary scleral flange, and thinner sclera posterior to the equator (P<0.001). ZHAC distance to the peripapillary ring was not significantly associated with length of parapapillary beta zone (P = 0.33). Including only non-highly myopic eyes (axial length <26.5 mm), the ZHAC distance to the disc border was not related with axial length (P = 0.84). In non-highly myopic eyes, the ZHAC was located close to the dura-sclera point. With increasing axial length and decreasing thickness of the peripapillary scleral flange, the ZHAC was located closer to the inner scleral surface.ConclusionsThe distance between the ZHAC and the optic disc border is markedly enlarged in highly myopic eyes. Since the ZHAC is the main arterial source for the lamina cribrosa blood supply, the finding may be of interest for the pathogenesis of the increased glaucoma susceptibility in highly myopic eyes.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 77%

Peripapillary Arterial Circle of Zinn-Haller: Location and Spatial Relationships with Myopia

2013

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“…As the peripapillary arterial circle of Zinn-Haller is located approximately at the merging point of the dura mater with the posterior sclera (ie, the starting point of the peripapillary scleral flange), 37 the high axial myopiaassociated elongation of the flange leads to an increased distance between the arterial circle of Zinn-Haller and the optic disc border (own data). 38 As the arterial circle is the main arterial source for the lamina cribrosa blood supply, 39,40 it has been discussed whether the high axial myopia induced increased distance between the arterial circle, and the lamina cribrosa may be of importance for the pathogenesis of an increased glaucoma susceptibility in highly myopic eyes.…”

Section: Optic Nerve Headmentioning

confidence: 99%

Histological changes of high axial myopia

Jonas

2013

Eye

129

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To describe pathological changes in the anatomy of highly myopic (axially elongated) eyes, enucleated globes were examined by light microscopy and ocular structures were measured histomorphometrically. These studies revealed that highly axially myopic eyes show continuous thinning of the sclera starting at or behind the equator with a maximal thinning at the posterior pole; a profound thinning of the choroid decreasing from B250 to o10 mm in extreme axial myopia, secondary macular defects in the Bruch's membrane associated with a complete loss of retinal pigment epithelium and choriocapillaris, and retinal photoreceptors; a Bruch's membrane of normal thickness in contrast to the profound thinning of the choroid and the sclera; an up to 10-fold elongation and thinning of the peripapillary scleral flange as anterior roof of the orbital cerebrospinal fluid space, and subsequently a retrobulbar extension of the cerebrospinal fluid space; an increased distance of the peripapillary arterial circle of Zinn-Haller to the optic disc border; an elongation and thinning of the lamina cribrosa with a subsequently decreased distance between the intraocular pressure compartment and the retrobulbar orbital cerebrospinal fluid pressure compartment; an increasing exposure of the peripheral posterior lamina cribrosa surface to the cerebrospinal fluid space, no longer buffered by the solid optic nerve tissue; and the development and enlargement of parapapillary gamma zone, in contrast to a myopia-independent parapapillary beta zone. These anatomical changes may be associated with high axial myopia-related complications such as an increased susceptibility of glaucomatous optic neuropathy and myopic retinopathy.

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“…Projection artifacts must be removed from surface vessels, and tissue cannot image deeply enough to capture the entire laminar and retrolaminar capillary beds that are likely relevant to the pathogenesis of not only glaucoma but non-arteritic anterior ischemic optic neuropathy (NAION) as well. 58 , 59 Application of a compensation algorithm to OCT images of the ONH greatly enhanced contrast, reduced blood-vessel shadows, and allowed for better visualization of the deeper portions of the ONH, but is not sufficient for LC visualization of vasculature or blood flow. 60 Other techniques, including optoacoustic, ultrasound, magnetic resonance imaging (MRI), and micro-computed tomography (CT) have excellent signal penetration but lack the spatial resolution required for detailed analysis of the LC.…”

Section: Discussionmentioning

confidence: 99%

Lamina Cribrosa Capillaries Straighten as Intraocular Pressure Increases

Brazile

Yang

Waxman

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Purpose The purpose of this study was to visualize the lamina cribrosa (LC) capillaries and collagenous beams, measure capillary tortuosity (path length over straight end-to-end length), and determine if capillary tortuosity changes when intraocular pressure (IOP) increases. Methods Within 8 hours of sacrifice, 3 pig heads were cannulated via the external ophthalmic artery, perfused with PBS to remove blood, and then perfused with a fluorescent dye to label the capillaries. The posterior pole of each eye was mounted in a custom-made inflation chamber for control of IOP with simultaneous imaging. Capillaries and collagen beams were visualized with structured light illumination enhanced imaging at IOPs from 5 to 50 mm Hg at each 5 mm Hg increment. Capillary tortuosity was measured from the images and paired two-sample t -tests were used to assess for significant changes in relation to changes in IOP. Results Capillaries were highly tortuous at 15 mm Hg (up to 1.45). In all but one eye, tortuosity decreased significantly as IOP increased from 15 to 25 mm Hg ( P < 0.01), and tortuosity decreased significantly in every eye as IOP increased from 15 to 40 mm Hg ( P < 0.01). In only 16% of capillaries, tortuosity increased with elevated IOP. Capillaries had a surprisingly different topology from the collagen beams. Conclusions Although high capillary tortuosity is sometimes regarded as potentially problematic because it can reduce blood flow, LC capillary tortuosity may provide slack that mitigates against reduced flow and structural damage caused by excessive stretch under elevated IOP. We speculate that low capillary tortuosity could be a risk factor for damage under high IOP.

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Detection of Zinn-Haller Arterial Ring in Highly Myopic Eyes by Simultaneous Indocyanine Green Angiography and Optical Coherence Tomography

Cited by 16 publications

References 23 publications

Peripapillary Arterial Circle of Zinn-Haller: Location and Spatial Relationships with Myopia

Peripapillary Arterial Circle of Zinn-Haller: Location and Spatial Relationships with Myopia

Histological changes of high axial myopia

Lamina Cribrosa Capillaries Straighten as Intraocular Pressure Increases

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