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Parapapillary atrophy: histological gamma zone and delta zone.

Jonas JB, Jonas SB, Jonas RA, Holbach L, Dai Y, Sun X, Panda-Jonas S - PLoS ONE (2012)

Bottom Line: 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.It was not significantly (P = 0.24) associated with glaucomatous optic neuropathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Germany. Jost.Jonas@umm.de

ABSTRACT

Background: To examine histomorphometrically the parapapillary region in human eyes.

Methodology/principal findings: The 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;r(2) = 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/significance: Parapapillary 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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Photomicrograph of a highly myopic optic nerve head (staining: PAS); black stars: inner border of the optic nerve; arrows #1: pia mater of the optic nerve; arrows #2: peripapillary scleral flange as roof of the widened orbital cerebrospinal fluid space; arrows #3: dura mater of the optic nerve; arrow #4: arterial circle of Zinn-Haller; A–B: Pia mater (potentially the “peripapillary scleral ring” upon ophthalmoscopy); B–C: Delta zone (no blood vessels >50 µm diameter within gamma zone); C–D: remaining Gamma zone (peripapillary sclera without overlying choroid, Bruch's membrane and deep retinal layers).
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pone-0047237-g004: Photomicrograph of a highly myopic optic nerve head (staining: PAS); black stars: inner border of the optic nerve; arrows #1: pia mater of the optic nerve; arrows #2: peripapillary scleral flange as roof of the widened orbital cerebrospinal fluid space; arrows #3: dura mater of the optic nerve; arrow #4: arterial circle of Zinn-Haller; A–B: Pia mater (potentially the “peripapillary scleral ring” upon ophthalmoscopy); B–C: Delta zone (no blood vessels >50 µm diameter within gamma zone); C–D: remaining Gamma zone (peripapillary sclera without overlying choroid, Bruch's membrane and deep retinal layers).

Mentions: Additionally we measured the thickness of the sclera at the limbus, ora serrata, equator, midpoint between the posterior pole and the equator, posterior pole and outside of the optic nerve head after merging of the optic nerve sheaths with the sclera. As “gamma zone”, we defined the region between the outer margin of the optic nerve (covered by pia mater) and the end of Bruch's membrane, if the end of Bruch's membrane did not overhang into the region of the optic nerve head (Fig. 1). “Delta zone” was a central part of gamma zone in which blood vessels of at least 50 µm diameter were not detected and which had a minimal length of 300 µm (Fig. 4). The choriocapillaris was considered not to be occluded if fine open capillaries of a diameter of about 10 to 20 µm were detectable just beneath Bruch's membrane. All measurements were performed before a discussion came up with further differentiating parapapillary atrophy into a new beta zone, a gamma zone and a delta zone. The diagnosis of glaucoma was based on the information obtained from the clinical charts and it was based on the light-microscopic appearance of the anterior chamber angle for the differentiation between open-angle glaucoma and secondary angle-closure glaucoma.


Parapapillary atrophy: histological gamma zone and delta zone.

Jonas JB, Jonas SB, Jonas RA, Holbach L, Dai Y, Sun X, Panda-Jonas S - PLoS ONE (2012)

Photomicrograph of a highly myopic optic nerve head (staining: PAS); black stars: inner border of the optic nerve; arrows #1: pia mater of the optic nerve; arrows #2: peripapillary scleral flange as roof of the widened orbital cerebrospinal fluid space; arrows #3: dura mater of the optic nerve; arrow #4: arterial circle of Zinn-Haller; A–B: Pia mater (potentially the “peripapillary scleral ring” upon ophthalmoscopy); B–C: Delta zone (no blood vessels >50 µm diameter within gamma zone); C–D: remaining Gamma zone (peripapillary sclera without overlying choroid, Bruch's membrane and deep retinal layers).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3475708&req=5

pone-0047237-g004: Photomicrograph of a highly myopic optic nerve head (staining: PAS); black stars: inner border of the optic nerve; arrows #1: pia mater of the optic nerve; arrows #2: peripapillary scleral flange as roof of the widened orbital cerebrospinal fluid space; arrows #3: dura mater of the optic nerve; arrow #4: arterial circle of Zinn-Haller; A–B: Pia mater (potentially the “peripapillary scleral ring” upon ophthalmoscopy); B–C: Delta zone (no blood vessels >50 µm diameter within gamma zone); C–D: remaining Gamma zone (peripapillary sclera without overlying choroid, Bruch's membrane and deep retinal layers).
Mentions: Additionally we measured the thickness of the sclera at the limbus, ora serrata, equator, midpoint between the posterior pole and the equator, posterior pole and outside of the optic nerve head after merging of the optic nerve sheaths with the sclera. As “gamma zone”, we defined the region between the outer margin of the optic nerve (covered by pia mater) and the end of Bruch's membrane, if the end of Bruch's membrane did not overhang into the region of the optic nerve head (Fig. 1). “Delta zone” was a central part of gamma zone in which blood vessels of at least 50 µm diameter were not detected and which had a minimal length of 300 µm (Fig. 4). The choriocapillaris was considered not to be occluded if fine open capillaries of a diameter of about 10 to 20 µm were detectable just beneath Bruch's membrane. All measurements were performed before a discussion came up with further differentiating parapapillary atrophy into a new beta zone, a gamma zone and a delta zone. The diagnosis of glaucoma was based on the information obtained from the clinical charts and it was based on the light-microscopic appearance of the anterior chamber angle for the differentiation between open-angle glaucoma and secondary angle-closure glaucoma.

Bottom Line: 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.It was not significantly (P = 0.24) associated with glaucomatous optic neuropathy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Germany. Jost.Jonas@umm.de

ABSTRACT

Background: To examine histomorphometrically the parapapillary region in human eyes.

Methodology/principal findings: The 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;r(2) = 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/significance: Parapapillary 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.

Show MeSH
Related in: MedlinePlus