Papillengruben in großen Papillae nervi optici. Papillometrische Charakteristika in 15 Augen

Abstract

Fifteen optic nerve heads with pits measured by optic disk planimetry according to Littmann and Jaeger's method were significantly larger than previously determined normal optic nerve heads. Their area measured 4.84 +/- 1.42 mm2 (2.77-8.02 mm2), their horizontal diameter 2.42 +/- 0.42 mm (1.76-3.38 mm) and their vertical diameter 2.53 +/- 0.30 mm (1.14-3.06 mm). The quotients of minimum to maximum diameter and the angle between the maximum diameter and the horizontal line were similar to those in normal optic disks. Because of their enlarged area but normal form this pathologic entity forms a subunit of macrodisks. The pits were located in 14 optic disks on the temporal side on average 100 degrees from the upper disk pole, and in two optic disks on the nasal side about 85 degrees from the upper pole. In two cases they were double and in one bilateral. Their area and number were significantly correlated (p less than 0.001 and p less than 0.05) to the area of the optic disk. With increasing optic nerve head size the optic cup was less excavated. The largest optic disk seen in this study did not have one at all. There might be a stepless continuation from normal-sized optic disks to macrodisks with physiologic macrocups and to optic nerve heads with pits. These represent a maximum extreme in the spectrum of optic disk anomalies and diseases associated with optic nerve head size.

Anatomic Relationship between Lamina Cribrosa, Intraocular Space, and Cerebrospinal Fluid Space

“…19 -21 A herniation of the lamina cribrosa into the widened cerebrospinal fluid space at the optic disc border may be the pathohistologic equivalent of acquired pits in the optic nerve head in glaucomatous eyes, as described by Spaeth et al 22 and Radius et al 23 The exposed region of the posterior surface of the lamina cribrosa to the cerebrospinal fluid space may also have importance for the pathogenesis of congenital pits of the optic nerve head which usually occur in abnormally large optic discs and are located close to the optic disc border. 24 The region with the shortest distance between the intraocular space and the cerebrospinal fluid pressure space was located in the periphery of the optic nerve head. Considering that a short distance between the intraocular space and the cerebrospinal fluid space steepens the pressure gradient, and assuming that a steep pressure gradient increases the susceptibility of optic nerve fibers to glaucoma, one may infer that optic nerve fibers located in the optic disc periphery should be more susceptible to glaucoma than fibers running through the optic disc center.…”

Lamina Cribrosa Thickness and Spatial Relationships between Intraocular Space and Cerebrospinal Fluid Space in Highly Myopic Eyes

“…Correspondingly, congenital pits of the optic nerve head which have also been considered a local herniation of a lamina cribrosa pore into the cerebrospinal fluid space have not been described frequently in highly myopic eyes. 31 The periphery of the optic nerve head was the region with the shortest distance between the intraocular space and the cerebrospinal fluid space. Assuming that a short distance between the cerebrospinal fluid space and the intraocular space steepens the pressure gradient and that a steep pressure gradient increases the susceptibility to glaucoma of optic nerve fibers, one may infer that optic nerve fibers located in the optic disc periphery would be more susceptible to glaucoma than fibers running through the optic disc center.…”

Anterior ischemic optic neuropathy: Nonarteritic form in small and giant cell arteritis in normal sized optic discs

“…The optic nerve heads with nonarteritic anterior ischemic optic neuropathy were not only smaller than unselected normal optic discs but also significantly smaller (p<0.0001) than so called 'congenital asymptomatic macrodiscs' [10], smaller than discs with pits [11] and smaller than discs with 'Morning-Glory-Syndrome' [16] (Table 2). They were significantly larger than optic nerve heads with drusen [17] and with pseudopapiUedema [18].…”

“…1; Table 1). They were significantly smaller (p<0.001) than 457 unselected normal optic discs (2.69 + -0.70mm 2) [13], smaller than 17 so called 'congenital asymptomatic macrodiscs' (4.91+ -0.34ram 2) [10], smaller than 15 optic nerve heads with pits (4.84 + -1.42 mm 2) [11], and smaller than 17 optic discs with 'Morning-GlorySyndrome' (7.47+ -2.63mm 2) [16]. They were significantly larger (p<0.001) than 26 optic nerve heads with drusen (1.79 + -0.50mm 2) [17], and larger than 35 unselected optic discs with pseudopapilledema (1.95 + -0.33 mm 2) [18] ( Table 2).…”