Abstract
Glaucoma specialists often overlook the outer retinal changes because the glaucomatous optic neuropathy typically involves retinal nerve fiber layer (RNFL). By detailed inspection of the outer retina in myopic eyes, we observed a separation of the inner nuclear layer (INL) from the outer nuclear layer (ONL) at the peripapillary sclera (pp-sclera). Therefore, we conducted a retrospective observation of 108 eyes of 108 Korean subjects with myopia assessed by swept-source optical coherence tomography (SSOCT) and divided into normal and glaucomatous eyes. Mean subject age, refractive error and axial length difference between 2 groups were insignificant, respectively. To quantify the ONL-INL separation, straight-line distance from ONL endpoint to INL endpoint was measured at the center of the optic disc by SSOCT horizontal scan. The glaucomatous group had significantly large ONL-INL separation than the non-glaucomatous group (p = 0.027) but had no significant difference in INL – Anterior scleral canal opening (ASCO) separation. The width of ONL-INL separation were associated with β-peripapillary atrophy (β-PPA), degree of horizontal tilt of the optic disc and worse glaucomatous RNFL defect by Pearson’s correlation analysis (all p < 0.001, respectively). In conclusion, we demonstrate transverse separation of INL from ONL at the peripapillary region, which was significantly associated with glaucomatous optic nerve damage. These observations may be of interest to elucidate the role of PPA in glaucoma pathogenesis and a clinical index to take notice for myopic subjects.
Highlights
Histologic investigations reveal that the ONH is a three-layered hole consisting of the Bruch’s membrane (BM), peripapillary choroid and peripapillary sclera[1,2,3]
Clinical observational studies regarding the PPA persistently suggest that the β-peripapillary atrophy (β-PPA) was associated with glaucoma, while γ-PPA was associated with axial myopia[8,9,10]
We describe transversely separated outer nuclear layer (ONL)-inner nuclear layer (INL) at the peripapillary region which was associated with glaucomatous parameters
Summary
Histologic investigations reveal that the ONH is a three-layered hole consisting of the Bruch’s membrane (BM), peripapillary choroid and peripapillary sclera[1,2,3]. By detailed inspection of the outer retina in myopic eyes, we observed a separation of the inner nuclear layer (INL) from the outer nuclear layer (ONL) at the parapapillary region. This separation observed in the PPA region of the myopes seemed to be related with glaucomatous damage and enlarged with accompanying enlargement of β-PPA. On the basis of this observation, we hypothesized that separation of the two retinal nuclear layers may interrupt the integrity of the peripapillary retina, leading to further optic nerve damage. The purpose of the present study was to describe the outer retinal separation in the peripapillary of glaucomatous myopes and to investigate factors associated with such changes
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