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Impressum
Anatomical Relationship between the Lamina Cribrosa and the Cerebrospinal Fluid Space in Normal and Glaucomatous Eyes.
1Nestel A., 2Holbach L., 1Jonas J. B.
1Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg; 2Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Erlangen.
Objective: The lamina cribrosa as bottom of the optic cup in the
optic nerve head faces the intraocular space on its interior side and
the optic nerve and the cerebrospinal fluid space (CSF) on its outer surface.
Since the lamina cribrosa acts as a pressure barrier between the intraocular
space and the retrobulbar space of the optic nerve, it is exposed to a
pressure gradient. It may thus have importance for the pathogenesis of
ocular diseases related to the intraocular pressure and cerebrospinal
fluid pressure, such as the glaucomas. The purpose of the present study
was to study the anatomical relationship between the lamina cribrosa and
the cerebrospinal fluid space in the retrobulbar region.
Patients and Methods: The study included 20 globes enucleated for
malignant melanoma (n=10) with a normal optic nerve, or enucleated due
to painful absolute secondary angle-closure glaucoma (n=10). For all eyes,
anterior-posterior PAS stained histological sections through the center
of the cornea and the center of the optic disc were available. These sections
were morphometrically evaluated.
Results: In the normal eyes and the glaucoma eyes, the part of
the lamina cribrosa exposed to the CSF space was located close to the
optic disc border. This lamina cribrosa part was significantly (P<0.01)
wider in the glaucoma eyes than in the normal eyes. Contrary, the shortest
distance between the intraocular space and the CSF space, and the thickness
of the lamina cribrosa were significantly (P<0.001) longer and greater
in the normal eyes than in the glaucoma eyes.
Conclusions: The measurements of the lamina cribrosa including
the measures of the anatomical relationship between the intraocular space
and the CSF space differ significantly between normal eyes and glaucoma
eyes. These data may be of importance for the pathogenesis of glaucomatous
optic neuropathy including the normal pressure glaucomas.