Size and Shape of Bruch's Membrane Opening in Relationship to Axial Length, Gamma Zone, and Macular Bruch's Membrane Defects

Qi, Zhang; Xu, Liang; Wei, Wen Bin; Wang, Ya Xing; Jonas, Jost B.

doi:10.1167/iovs.19-27331

Cited by 59 publications

(77 citation statements)

References 40 publications

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“…However, this relationship seems to be non-linear in clinical practice, and Jonas et al 1 described the prevalence and size of PPA −BM increased steeply, starting at an axial length of 26.5 mm, in their histomorphometric investigations of human globes. Recently, Zhang et al 20,21 demonstrated a steep increase in BMO diameters beyond an axial length of 26.0 mm and reported that such BMO enlargement was significantly associated with the large PPA −BM in myopic eyes. Similarly, we found a significant positive association between the PPA −BM width and BMO area, after adjusting for significant confounders.…”

Section: Discussionmentioning

confidence: 99%

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Sung

Heo

Piao

et al. 2020

Sci Rep

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We investigated the relationship between microstructure of β-parapapillary atrophy (β-ppA) and morphologic features of optic nerve head (onH) and posterior pole in highly myopic eyes. eighty-nine highly myopic eyes were included in this study. Bruch's membrane opening (BMo) area, lamina cribrosa (Lc) thickness, anterior laminar depth, peripapillary and subfoveal choroidal thickness (ct), macular Bruch's membrane (BM) length, and width of β-ppA with and without Bruch's membrane (ppA +BM and ppA −BM ) were evaluated. The mean age and axial length of the included subjects were 26.88 ± 2.44 years and 27.03 ± 0.88 mm, respectively. The width of PPA −BM was larger with increasing BMo area (P = 0.001), whereas the BMO area was not associated with the width of PPA +BM . the large ppA +BM was significantly related to a thinner LC (P = 0.003), deeper anterior lamina surface (P < 0.001), longer macular BM length (P = 0.008), and thinner temporal peripapillary CT (P = 0.034). We found that the morphologic features of the ONH and posterior pole in highly myopic eyes were different based on the microstructure of β-ppA. Whether these features are linked to the development of glaucoma in myopic eyes should be investigated in future studies.Classic funduscopic β-parapapillary atrophy (β-PPA) is a region of visible large choroidal vessels and sclera due to the lack of retinal pigment epithelium (RPE). β-PPA can be histologically subclassified based on the presence or absence of Bruch's membrane (BM): β-PPA with BM (PPA +BM ; β zone) and β-PPA without BM (PPA −BM ; γ zone). It has been known that PPA +BM might be due to age-related atrophy of the RPE and associated with the development of glaucoma 1-4 . Whereas, PPA −BM has been considered as a result of mechanical stretching in the peripapillary sclera and border tissue during axial elongation; hence a significant association between axial length and PPA −BM width has been consistently reported 1-3,5 . However, we previously reported that PPA +BM was also found in 20-30-year-old myopia subjects and suggested that PPA +BM in young myopia patients might be related to axial elongation, not age-related atrophy 6 . In accordance with our report, Lee et al. 7 recently found an enlargement of PPA +BM as myopia progressed and proposed that PPA +BM found in children might be an entirely different entity from PPA +BM in elderly individuals, sharing an etiology with PPA −BM .Several factors might contribute to β-PPA development during axial elongation, but the etiology of PPA +BM and PPA −BM enlargement remains elusive so far. It is unclear why some myopia patients exhibit only PPA −BM , whereas others with a similar degree of myopia exhibit both PPA +BM and PPA −BM . In this study, we hypothesized that morphologic features of the optic nerve head (ONH) and the posterior pole might give clues to the mechanisms of differential developments of β-PPA in myopic eyes. Therefore, the purpose of this work was to investigate the relationship between microstructure of β-PPA and the morphologic featur...

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Section: Discussionmentioning

confidence: 99%

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Sung

Heo

Piao

et al. 2020

Sci Rep

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“…The optic nerve head can be regarded as a three-layered hole in the coats of the globe, with BM opening forming the inner layer, the choroidal opening the middle layer, and the scleral opening covered by the lamina cribrosa forming the outer layer. A recent optical coherence tomographical study showed that in medium myopic eyes the three layers often are not aligned to each other but that medium myopic eyes often show an overhanging of BM into the intrapapillary region on the nasal side of the optic disc 13 . Correspondingly, there is a lack of BM at the temporal optic disc side what is the equivalent of parapapillary gamma zone (as defined by the absence of BM).…”

Section: Discussionmentioning

confidence: 99%

Retinal Pigment Epithelium Cell Density and Bruch’s Membrane Thickness in Secondary versus Primary High Myopia and Emmetropia

Jonas

Dong

Holbach

et al. 2020

Sci Rep

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To assess differences between secondary high myopia (SHM) due to congenital glaucoma and primary high myopia (PHM) and non-highly myopic eyes (NHM) in the relationships between axial length and Bruch's membrane (BM) thickness and retinal pigment epithelium (RPE) density. The histomorphometric study included human globes enucleated for reasons such as malignant uveal melanoma, end-stage painful secondary angle-closure glaucoma and congenital glaucoma. BM thickness and RPE cell density were measured upon light microscopy. The investigation included 122 eyes (mean axial length: 26.7 ± 3.7 mm; range: 20.0-37.0 mm): 7 eyes with SHM (axial length: 33.7 ± 2.1 mm; range: 31.0-37.0 mm), 56 eyes with PHM (mean axial length: 29.1 ± 2.4 mm; range: 26.0-36.0 mm) and 59 eyes in the NHM-group (axial length: 23.5 ± 1.3 mm; range: 20.0-25.5 mm). In the SHM group, longer axial length was associated with lower RPE cell density at the posterior pole (standardized regression coefficient beta: 0.92; non-standardized regression coefficient B: −2.76; 95% confidence interval (CI): −4.41, −1.10;P = 0.01), at the midpoint posterior pole/equator (beta: −0.87; B: −3.60; 95% CI: −6.48, −0.73;P = 0.03), and at the equator (beta: −0.88; B: −0.95; 95% CI: −1.68, −0.23; P = 0.02), but not at the ora serrata (P = 0.88). In the PHM-group and NHM group, RPE cell density at the posterior pole (P = 0.08) and ora serrata (P = 0.88) was statistically independent of axial length, while at the midpoint posterior pole/equator (P = 0.01) and equator (P < 0.001), RPE cell density decreased with longer axis. BM thickness in the SHM group decreased with longer axial length at the posterior pole (beta: −0.

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“…We did not take into account potential differences in the anatomy and biomechanical properties of the various layers of the LC, nor did we consider lateral movements of the LC in dependence of changes of the examined parameters and in dependence of the obliqueness of the optic nerve canal and the spatial relationship between Bruch’s membrane opening and the lamina cribrosa position. 66, 67…”

Section: Discussionmentioning

confidence: 99%

Effect of Changing Heart Rate on the Ocular Pulse and Dynamic Biomechanical Behavior of the Optic Nerve Head

Jin

Wang

Irnadiastputri

et al. 2019

Preprint

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ABSTRACTPurposeTo study the effect of changing heart rate on the ocular pulse and the dynamic biomechanical behaviour of the optic nerve head (ONH) using a comprehensive mathematical model.MethodsIn a finite element model of a healthy eye, a biphasic choroid consisted of a solid phase with connective tissues and a fluid phase with blood, and the lamina cribrosa (LC) was viscoelastic as characterized by a stress-relaxation test. We applied arterial pressures at 18 ocular entry sites (posterior ciliary arteries) and venous pressures at four exit sites (vortex veins). In the model, the heart rate was varied from 60 bpm to 120 bpm (increment: 20 bpm). We assessed the ocular pulse amplitude (OPA), pulse volume, ONH deformations and the dynamic modulus of the LC at different heart rates.ResultsWith an increasing heart rate, the OPA decreased by 0.04 mmHg for every 10 bpm increase in heart rate. The ocular pulse volume decreased linearly by 0.13 µL for every 10 bpm increase in heart rate. The storage modulus and the loss modulus of the LC increased by 0.014 MPa and 0.04 MPa, respectively, for every 10 bpm increase in heart rate.conclusionsIn our model, the OPA, pulse volume, and ONH deformations decreased with an increasing heart rate, while the LC became stiffer. The effects of blood pressure / heart rate changes on ONH stiffening may be of interest for glaucoma pathology.SupportSingapore Ministry of Education, Academic Research Fund, Tier 2 (R-397-000-280-112).Commercial relationshipNone

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Size and Shape of Bruch's Membrane Opening in Relationship to Axial Length, Gamma Zone, and Macular Bruch's Membrane Defects

Cited by 59 publications

References 40 publications

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Parapapillary atrophy and changes in the optic nerve head and posterior pole in high myopia

Retinal Pigment Epithelium Cell Density and Bruch’s Membrane Thickness in Secondary versus Primary High Myopia and Emmetropia

Effect of Changing Heart Rate on the Ocular Pulse and Dynamic Biomechanical Behavior of the Optic Nerve Head

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