Jonas Shefali B, Jonas Rahul A, Panda-Jonas Songhomitra, Jonas Jost B
Hannover Medical School, Hannover, Germany.
Department of Ophthalmology, Medical Faculty, University of Cologne, Cologne, Germany.
Acta Ophthalmol. 2022 Feb;100(1):111-117. doi: 10.1111/aos.14894. Epub 2021 May 6.
To search for the histological correlate of peripheral 'cobblestones' in highly myopic eyes.
The histomorphometric investigation included histologic sections of enucleated eyes of Caucasian patients. Using light microscopy, we measured the thickness of the retina, Bruch's membrane (BM) and choriocapillaris.
The study included 50 eyes (mean age:60.6 ± 18.7 years;axial length:26.5 ± 3.8 mm), with cobblestone regions detected in 7 eyes. BM thickness and choriocapillaris thickness in the cobblestone region were thinner (1.1 ± 0.2 µm versus 2.4 ± 0.8 µm; p < 0.001 and 1.6 ± 0.5 µm versus 2.6 ± 1.9 µm; p = 0.02, respectively), and just outside of the cobblestone region they were thicker (3.3 ± 0.6 µm versus 2.4 ± 0.8 µm; p = 0.005 and 5.7 ± 1.6 µm versus 2.6 ± 1.9 µm; p = 0.002, respectively) than in corresponding regions of eyes without cobblestones. Within the group of eyes with cobblestones, BM thickness (1.1 ± 0.2 mm versus 3.3 ± 0.6 mm; p < 0.001), choriocapillaris thickness (1.6 ± 0.5 mm versus 5.7 ± 1.6 mm; p < 0.001) and choriocapillaris density (48±15 µm/300 µm versus 159 ± 66 µm/300 µm;PP=0.002) were significantly lower in the cobblestone region than just outside of the cobblestone region. The cobblestone regions were characterized by firm adhesion of disorganized retina with thinned BM, few retinal pigment epithelium (RPE) islands within cobblestone regions, and absence of regional scleral or overall choroidal thinning. BM was mono-layered within, and double-layered outside of cobblestone regions, with the inner layer missing within the cobblestone region (except for the RPE islands).
Peripheral cobblestone regions in highly myopic eyes are characterized by marked BM thinning with absence of an inner BM layer, almost complete RPE absence, choriocapillaris thinning and firm connection of a disorganized retina to BM. These findings may help elucidating the process of axial elongation in myopic eyes.
探寻高度近视眼周边“鹅卵石样改变”的组织学关联。
组织形态计量学研究纳入了白种人患者摘除眼球的组织切片。运用光学显微镜，我们测量了视网膜、布鲁赫膜（BM）和脉络膜毛细血管的厚度。
该研究包含50只眼（平均年龄：60.6±18.7岁；眼轴长度：26.5±3.8毫米），其中7只眼检测到鹅卵石样区域。鹅卵石样区域的BM厚度和脉络膜毛细血管厚度更薄（分别为1.1±0.2微米对2.4±0.8微米；p<0.001以及1.6±0.5微米对2.6±1.9微米；p=0.02），而在鹅卵石样区域之外它们更厚（分别为3.3±0.6微米对2.4±0.8微米；p=0.005以及5.7±1.6微米对2.6±1.9微米；p=0.002），相较于无鹅卵石样改变的眼的相应区域。在有鹅卵石样改变的眼组中，鹅卵石样区域的BM厚度（1.1±0.2毫米对3.3±0.6毫米；p<0.001）、脉络膜毛细血管厚度（1.6±0.5毫米对5.7±1.6毫米；p<0.001）和脉络膜毛细血管密度（48±15微米/300微米对159±66微米/300微米；p=0.002）显著低于鹅卵石样区域之外。鹅卵石样区域的特征为紊乱的视网膜与变薄的BM紧密粘连，鹅卵石样区域内视网膜色素上皮（RPE）岛极少，且无局部巩膜或整体脉络膜变薄。BM在鹅卵石样区域内为单层，在其外为双层，在鹅卵石样区域内内层缺失（RPE岛除外）。
高度近视眼的周边鹅卵石样区域的特征为BM显著变薄且内层BM缺失，几乎完全没有RPE，脉络膜毛细血管变薄以及紊乱的视网膜与BM紧密相连。这些发现可能有助于阐明近视眼眼轴伸长的过程。
