Anatomy and Pathology/Oncology Retinal Thickness and Axial Length

PURPOSE. To examine the relationships between axial length and foveal and peripheral retinal thickness. METHODS. Using optical coherence tomography, foveal retinal thickness was measured in participants of the population-based Beijing Eye Study without optic nerve or macula diseases. Inner and outer nuclear layer thickness as surrogate for retinal thickness was assessed in the fundus periphery in human globes enucleated due to malignant uveal melanoma or painful glaucoma. RESULTS. The study included 1117 individuals with a mean age of 64.2 6 9.7 years (range: 50-93 years) and mean axial length of 23.4 6 1.04 mm (range: 20.29-28.68 mm). In multivariate analysis, thicker central foveal thickness was associated with male sex (P < 0.001; standardized regression coefficient beta: À0.13; nonstandardized regression coefficient B: À5.84; 95% confidence interval (CI): À8.56, À3.13); urban region of habitation (P ¼ 0.02; beta: 0.07; B: 3.56; 95% CI: 0.55, 6.57); thinner lens thickness (P ¼ 0.01; beta: À0.08; B: À5.11; 95% CI: À9.01, À1.21); thinner subfoveal choroidal thickness (P ¼ 0.04; beta: À0.07; B: À0.01; 95% CI: À0.03, À0.001); and longer axial length (P < 0.001; beta: 0.18; B: 3.79; 95% CI: 2.41, 5.17). In the same multivariate model, superior, inferior, and temporal foveal thickness was not significantly associated with axial length (P ¼ 0.26, P ¼ 0.19, P ¼ 0.08, respectively), while thicker nasal foveal thickness was associated with longer axial length (P ¼ 0.009; beta: 0.09; B: 1.50; 95% CI: 0.37, 2.62). In the histomorphometric part of the study including 32 eyes (sagittal diameter: 27.0 6 4.2 mm; range: 22-37 mm), mean thickness of the inner and outer nuclear layers at the equator and at the midpoint equator/posterior pole decreased with longer axial length (P ¼ 0.004; beta: À0.48; and P ¼ 0.02; beta: À0.44, respectively). CONCLUSIONS. Myopic axial globe elongation was associated with retinal thinning in the equatorial and pre-equatorial region, while foveal retinal thickness was mostly unaffected by axial length. It suggests that axial elongation takes place predominantly in the equatorial and pre-equatorial region of the eye

Primary ductal adenocarcinoma of the lacrimal gland: case report

A 78-year-old male patient presented with double vision, painless palpable mass under the right superolateral orbital rim, downward displacement and restricted adduction of the right eye. His visual acuity was 20/50 OD and 20/20 OS. Hertel exophthalmometry was 21 mm OD and 17 mm OS. Computed tomographic scans showed an infiltrative orbital mass with ill-defined, irregular margins, involving the lacrimal gland and the lateral rectus muscle. The patient underwent an anterior transcutaneous transseptal orbitotomy with incisional biopsy and surgical debulking. Histopathologic evaluation revealed primary ductal adenocarcinoma of the lacrimal gland. Following the metastatic work up, he underwent an eyelid-sparing orbital exenteration. Microscopically, the tumor elements were characterized by large polygonal cells with vesicular nuclei, prominent nucleoli and amphophilic cytoplasm. The tumor components comprised duct-type structures with papillary and cribriform patterns, surrounded by prominent basement membrane. The tumor cells were positive for cytokeratin-7, matrix metalloproteinase (MMP)-2, MMP-9, MMP-13 and proto-oncogene Her-2/neu, but negative for cytokeratin-5, cytokeratin-20, p63, prostate-specific antigen, S-100 protein and thyroid transcription factor. These histopathologic findings were compatible with poorly differentiated ductal adenocarcinoma of the lacrimal gland, T3N0M0. Twenty-four months after orbital exenteration, the patient was diagnosed with ipsilateral parotid gland and cervical lymph node metastases and died of disease

Peripapillary Arterial Circle of Zinn-Haller: Location and Spatial Relationships with Myopia

Purpose To measure histomorphometrically the location of the peripapillary arterial circle of Zinn-Haller (ZHAC) and assess its associations with axial length. Methods Using a light microscope, we measured the distance from the ZHAC to the peripapillary ring (optic disc border), the merging point of the dura mater with the posterior sclera (“dura-sclera point”), and the inner scleral surface. In the parapapillary region, we differentiated between beta zone (presence of Bruch's membrane, absence of retinal pigment epithelium) and gamma zone (absence of Bruch's membrane). The peripapillary scleral flange as roof of the orbital cerebrospinal fluid space was the connection between the end of the lamina cribrosa and the posterior full-thickness sclera starting at the dura-sclera point. Results The study included 101 human globes (101 patients) with a mean axial length of 26.7±3.7 mm (range: 20.0–39.0 mm). The distance between the ZHAC and the peripapillary ring increased significantly with longer axial length (P<0.001; correlation coefficient r = 0.49), longer parapapillary gamma zone (P<0.001;r = 0.85), longer (P<0.001;r = 0.73) and thinner (P<0.001;r = −0.45) peripapillary scleral flange, and thinner sclera posterior to the equator (P<0.001). ZHAC distance to the peripapillary ring was not significantly associated with length of parapapillary beta zone (P = 0.33). Including only non-highly myopic eyes (axial length <26.5 mm), the ZHAC distance to the disc border was not related with axial length (P = 0.84). In non-highly myopic eyes, the ZHAC was located close to the dura-sclera point. With increasing axial length and decreasing thickness of the peripapillary scleral flange, the ZHAC was located closer to the inner scleral surface. Conclusions The distance between the ZHAC and the optic disc border is markedly enlarged in highly myopic eyes. Since the ZHAC is the main arterial source for the lamina cribrosa blood supply, the finding may be of interest for the pathogenesis of the increased glaucoma susceptibility in highly myopic eyes

Histology of myopic posterior scleral staphylomas

Purpose Since histomorphometric descriptions of posterior scleral staphylomas, although forming a major part of myopic maculopathy, have been scarce so far, we histomorphometrically examined scleral staphylomas in enucleated human eyes. Methods Using light microscopy, we histomorphometrically examined sagittal histological sections of human globes enucleated due to malignant choroidal melanomas or secondary angle‐closure glaucoma. Results Out of 246 globes included into the study, posterior scleral staphylomas were detected in 10 eyes (mean length: 31.4 ± 3.0 mm; range: 28.0–37.0 mm). In the staphylomatous region in the study group as compared with the corresponding region of a control group adjusted for age and axial length, scleral thickness was significantly lower (109 ± 25 µm versus 319 ± 161 µm; p = 0.001). The study group in the staphylomatous region as compared to the highly myopic control group in the corresponding region did not differ significantly in retinal pigment epithelium (RPE) cell density (19.6 ± 4.9 cells/300 µm versus 21.1 ± 5.7 cells/300 µm; p = 0.84) and RPE height (8.2 ± 2.8 µm versus 6.1 ± 2.5 µm; p = 0.13), Bruch’s membrane (BM) thickness (3.5 ± 1.3 µm versus 4.2 ± 2.3 µm; p = 0.40) and choriocapillaris thickness (5.3 ± 2.8 µm versus 4.4 ± 2.8 µm; p = 0.49) and density (164 ± 99 µm versus 226 ± 38 µm; p = 0.13). All staphylomatous regions showed a localized BM defect. Conclusions Marked scleral thinning and spatially correlated BM defects histologically characterized myopic scleral staphylomas, while thickness and density of the choriocapillaris and RPE and BM thickness did not differ significantly between staphylomatous versus non‐staphylomatous eyes in the respective regions. These findings support the notion that a locally reduced scleral resistance against a backward pushing BM led to a local scleral outpouching. The outpouching‐associated increase in curvature length may stretch BM with the sequel of a localized BM rupture

Photograph showing the measurement points of scleral thickness.

<p>Photograph showing the measurement points of scleral thickness.</p

Histophotograph showing the optic nerve head of a non-highly myopic eyes with the peripapillary arterial circle of Zinn-Haller (red arrows), located at the merging point of the dura mater (black arrows) with the scleral at the end of the peripapillary scleral flange (between green arrows), the pia mater (yellow arrows), and the peripapillary ring (white arrows).

<p>Histophotograph showing the optic nerve head of a non-highly myopic eyes with the peripapillary arterial circle of Zinn-Haller (red arrows), located at the merging point of the dura mater (black arrows) with the scleral at the end of the peripapillary scleral flange (between green arrows), the pia mater (yellow arrows), and the peripapillary ring (white arrows).</p

Measurements of the scleral cross sectional area (mm²) and estimated scleral volume (mm³).

<p>Measurements of the scleral cross sectional area (mm²) and estimated scleral volume (mm³).</p

Graph showing the distribution of the distance between the peripapillary arterial circle of Zinn-Haller (ZHAC) and the inner scleral surface in relation to axial length.

<p>Graph showing the distribution of the distance between the peripapillary arterial circle of Zinn-Haller (ZHAC) and the inner scleral surface in relation to axial length.</p

Histo-photograph showing the location of the scleral thickness measurement (between the two red arrows) at the merging point of dura mater with the posterior sclera.

<p>Histo-photograph showing the location of the scleral thickness measurement (between the two red arrows) at the merging point of dura mater with the posterior sclera.</p