Histomorphometry of the circular peripapillary arterial ring of Zinn–Haller in normal eyes and eyes with secondary angle‐closure glaucoma

Jonas, Jost B.; Jonas, Shefali B.

doi:10.1111/j.1755-3768.2010.02022.x

Cited by 38 publications

(29 citation statements)

References 39 publications

(22 reference statements)

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“…Further, the elongation of the peripapillary sclera leads to the increased distance between the peripapillary arterial circle of Zinn-Haller and the optic disc border [40, 41]. Since the arterial circle of Zinn-Haller supports the blood vessels in the optic disc, particularly in lamina cribrosa [42], the increased distance may cause a malperfusion of lamina cribrosa. These mechanisms are hypothesized to explain increased glaucoma susceptibility in highly myopic eyes.…”

Section: Discussionmentioning

confidence: 99%

Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

et al. 2017

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PurposeThe influence of myopia on glaucoma progression remains unknown, possibly because of the multifactorial nature of glaucoma and difficulty in assessing a solo contribution of myopia. The purpose of this study is to investigate the association of myopia with visual field (VF) progression in glaucoma using a paired-eye design to minimize the influence of confounding systemic factors that are diverse among individuals.MethodsThis retrospective study evaluated 144 eyes of 72 subjects with open-angle glaucoma, with similar intra-ocular pressure between paired eyes, spherical equivalent (SE) ≤ -2 diopter (D), and axial length ≥ 24 mm. Paired eyes with faster and slower VF progression were grouped separately, according to the global VF progression rate assessed by automated pointwise linear regression analysis. The SE, axial length, tilt ratio and torsion angle of optic discs, Bruch’s membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were compared between the two groups. Factors associated with faster VF progression were determined by logistic regression analysis.ResultsThe mean follow-up duration was 8.9 ± 4.4 years. The mean value of SE and axial length were -6.31 ± 1.88 D and 26.05 ± 1.12 mm, respectively. The mean global visual field progression rate was -0.32 ± 0.38 dB/y. Tilt ratio, BM opening area, and gamma zone PPA width were significantly greater in the eyes with faster VF progression than those with slower progression. In multivariate analysis, these factors were significantly associated with faster VF progression (all P < 0.05), while SE and axial length were not associated with it.ConclusionIn myopic glaucoma subjects, tilt of the optic disc and temporal shifting and enlargement of the BM opening were associated with faster rate of VF progression between paired eyes. This suggests that myopia influences VF progression in glaucomatous eyes via optic disc deformations rather than via refractive error itself.

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Section: Discussionmentioning

confidence: 99%

Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

et al. 2017

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“…In addition to the thinning of the peripapillary scleral flange, the paucity of larger vessels in delta zone and the increased distance between the peripapillary arterial circle of Zinn-Haller and the optic disc border in highly myopic eyes (Fig. 4) may be an additional factor for the increased glaucoma susceptibility in highly myopic eyes [21].…”

Section: Discussionmentioning

confidence: 99%

Parapapillary Atrophy: Histological Gamma Zone and Delta Zone

et al. 2012

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BackgroundTo examine histomorphometrically the parapapillary region in human eyes.Methodology/Principal FindingsThe histomorphometric study included 65 human globes (axial length:21–37 mm). On anterior-posterior histological sections, we measured the distance Bruch's membrane end (BME)-optic nerve margin (“Gamma zone”), BME-retinal pigment epithelium (RPE) (“Beta zone”), BME-beginning of non-occluded choriocapillaris, and BME-beginning of photoreceptor layer. “Delta zone” was defined as part of gamma zone in which blood vessels of at least 50 µm diameter were not present over a length of >300 µm. Beta zone (mean length:0.35±0.52 mm) was significantly (P = 0.01) larger in the glaucoma group than in the non-glaucomatous group. It was not significantly (P = 0.28) associated with axial length. Beta zone was significantly (P = 0.004) larger than the region with occluded choriocapillaris. Gamma zone (mean length:0.63±1.25 mm) was associated with axial length (P<0.001;r2 = 0.73) with an increase starting at an axial length of 26.5 mm. It was not significantly (P = 0.24) associated with glaucomatous optic neuropathy. Delta zone (present only in eyes with axial length of ≥27 mm) was associated with axial length (P = 0.001) and scleral flange length (P<0.001) but not with glaucoma (P = 0.73).Conclusions/SignificanceParapapillary gamma zone (peripapillary sclera without overlying choroid, Bruch's membrane and deep retinal layers) was related with axial globe elongation and was independent of glaucoma. Delta zone (no blood vessels >50 µm diameter within gamma zone) was present only in highly axially elongated globes and was not related with glaucoma. Beta zone (Bruch's membrane without RPE) was correlated with glaucoma but not with globe elongation. Since the region with occluded choriocapillaris was smaller than beta zone, complete loss of RPE may have occurred before complete choriocapillaris closure.

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“…As the peripapillary scleral flange is the biomechanical anchor of the lamina cribrosa, any weakening of the flange, such as thinning, may have a consequence for the biomechanical stability of the lamina cribrosa and the fibers passing through it. 36 The peripapillary border tissue ('of Elschnig') is in its thickness mostly independent of the axial length of the globe (own data). The so-called peripapillary ring is probably just the peripapillary border tissue that is the continuation of the pia mater of the optic nerve.…”

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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Histomorphometry of the circular peripapillary arterial ring of Zinn–Haller in normal eyes and eyes with secondary angle‐closure glaucoma

Cited by 38 publications

References 39 publications

Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

Parapapillary Atrophy: Histological Gamma Zone and Delta Zone

Histological changes of high axial myopia

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