The Optic Disk, Optic Nerve Head, or Papilla
Normally is seen ophthalmoscopically as a round or slightly ovoid yellow-pink structure.
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Contents 23.1
Vessels of the Optic Nerve and Papilla ..... 324
23.2
Embryology ................................................ 325
23.3
Correlation Between Pathological Anatomy and Optic Nerve Computerized Tomography (HRT): New Definition of the Histological Nomenclature ............................................. 325 Introduction.................................................. 325
23.3.1 23.4
Parameters Used for Glaucoma Staging......................................................... 332
23.5
Correlation Between the Parameters of the Optic Disk in HRT with the Anatomy ............................................... 334
23.6
Correlation Between Histology and HRT in a Normal and Glaucomatous Optic Disk .................. 334
23.7
Correlation Between Histology and HRT in a Glaucomatous Optic Disk ................................................... 335
23.8
Evolution of the Optic Disk from Normal to Glaucomatous Cupping .......... 335
References ................................................................. 339
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Normally is seen ophthalmoscopically as a round or slightly ovoid yellow-pink structure. The optic nerve head can be conveniently divided into the following: • The surface layer • The prelaminar region • The cribriform lamina (Fig. 23.1) The surface layer consists of nerve fibers that are separated from the overlying vitreous body by the internal limiting membrane of Elschnig, derived from astrocytes. In the center is an accumulation of glial cells, known as the central meniscus of Kuhnt. The prelaminar region or choroidal lamina cribrosa is characterized by the segregation of retinal nerve fibers into approximately 1,000 bundles. This fascicles are separated by astroglia (spider cells). The lamina cribrosa region or posterior lamina cribrosa are fenestrated connective tissue, continuous with the surrounding sclera. This connective tissue are very important in your immunohistochemical constitution (external scleral Schlemm ductus tissue-like), and this region provides support for the axons of the ganglion cells of the retina. The blood supply is derived from both the central retinal and posterior ciliary arterial circulations (Fig. 23.2).
R. Sampaolesi et al., The Glaucomas, DOI 10.1007/978-3-642-35500-4_23, © Springer-Verlag Berlin Heidelberg 2014
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324 Fig. 23.1 Optic and optic disk: surface layer, prelaminar region, and cribriform lamina (Zarate-Sampaolesi) [1]
The Optic Disk, Optic Nerve Head, or Papilla
Venous vessel
Meniscus of kuhnt Surface layer
Prelaminar surface
Cribiform lammina
Fig. 23.2 Optic nerve and optic disk vessels. ACNO central arteria of the optic nerve, ACR central arteria of the retina, ACPC short ciliary posterior arteria, 1 Zinn-Haller plexus (Sampaolesi)
23.1
Vessels of the Optic Nerve and Papilla
The optic nerve in the region nearest to the eye is irrigated by a centrifugal system formed by the central artery of the optic nerve or François (CAON) artery. This artery might be a branch of the ophthalmic central artery (OCA) before enterin
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