Parapapillary Gamma Zone Hole

Abstract

To describe the appearance of a defect in the parapapillary region of a highly myopic eye. During a routine ophthalmologic examination, in a 26-year-old man with a visual acuity of 0.80 and a refractive error of -10.25 D, a dehiscence in the parapapillary region was detected. A choroidal vessel appeared to emerge out of the dehiscence : Optical coherence tomography (OCT) revealed an apparent hole in the underlying scleral wall opening into a retrobulbar empty space. The latter was delimited by the dura mater as shown by a vertical bright band. Inside of the dura mater, the retrobulbar orbital cerebrospinal fluid space was widened. Interestingly, the same eye showed a parapapillary intrachoroidal cavitation almost completely hiding the main temporal inferior vessel branch. In addition, the optic disc was vertically rotated and slightly obliquely tilted so that its en face appearance was smaller than its surface as it appeared on the OCT image. The OCT revealed a parapapillary gamma zone hole in a highly myopic eye in association with a vertically rotated and slightly tilted optic disc with an inferior parapapillary intrachoroidal cavitation. The illustration may show the usefulness of the differentiation between the beta zone, gamma zone, and delta zone in the parapapillary region.