March 2013
Volume 54, Issue 3
Letters to the Editor  |   March 2013
Macular Migration toward the Optic Disc after Inner Limiting Membrane Peeling
Author Notes
Investigative Ophthalmology & Visual Science March 2013, Vol.54, 2019. doi:10.1167/iovs.13-11881
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      Jost B. Jonas; Macular Migration toward the Optic Disc after Inner Limiting Membrane Peeling. Invest. Ophthalmol. Vis. Sci. 2013;54(3):2019. doi: 10.1167/iovs.13-11881.

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      © ARVO (1962-2015); The Authors (2016-present)

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Yoshikawa and colleagues are to be congratulated for their study on a shortened papillofoveal distance after vitrectomy for diabetic macular edema. 1 Recent clinical and population-based studies have shown that the choroidal thickness decreases by approximately 32 μm for every millimeter increase in axial length in myopic eyes. 2,3 It suggests that in high myopia, Bruch's membrane undergoes changes in its length in an amount at least as marked as the sclera does. Otherwise, the distance between sclera and Bruch's membrane (i.e., the choroid) would have enlarged with increasing axial myopia. Consequently, the hypothesis of a “sliding Bruch's membrane theory” was formulated in a recent study on the patho-histology of highly myopic eyes, based on the fact that Bruch's membrane is connected with the sclera only by the spongy choroid, but not by a firm solid inflexible structure. 4 If now Yoshikawa and colleagues found a shortening of the distance between the fovea and the optic disc, one may wonder whether this change in position of the fovea was due to a shifting of the retina, including the retinal photoreceptors, on the sheet of the retinal pigment epithelium cells (which appear to be firmly connected to their basal lamina, which is the inner part of Bruch's membrane), or whether the change in the position of the fovea may have been due to a shifting or sliding of Bruch's membrane on the spongy choroid in the direction of the optic disc. If the latter theory is valid, one would postulate that the parapapillary region, in particular the recently defined parapapillary gamma zone, may have decreased in those eyes that experienced a translocation of the fovea in the direction of the optic nerve head. 5 A similar finding was recently reported for eyes after a pronounced reduction in intraocular pressure. 6 Yoshikawa and colleagues may be asked whether they could observe changes in the position of Bruch's membrane and in choroidal thickness, as well as changes in the appearance of the parapapillary region, parallel to changes in the position of the fovea, in the eyes after peeling of the inner limiting membrane. 
Yoshikawa M Murakami T Nishijima K Macular migration toward the optic disc after inner limiting membrane peeling for diabetic macular edema. Invest Ophthalmol Vis Sci . 2013; 54: 629–635. [CrossRef] [PubMed]
Fujiwara T Imamura Y Margolis R Slakter JS Spaide RF. Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes. Am J Ophthalmol . 2009; 148: 445–450. [CrossRef] [PubMed]
Wei WB Xu L Jonas JB Subfoveal choroidal thickness: the Beijing Eye Study. Ophthalmology . 2013; 120: 175–180. [CrossRef] [PubMed]
Jonas JB Ohno-Matsui K Spaide RF Holbach L Panda-Jonas S. Macular Bruch's membrane holes in high myopia: associated with gamma zone and delta zone of parapapillary region. Invest Ophthalmol Vis Sci . 2013; 54: 1295–1302. [CrossRef] [PubMed]
Jonas JB Jonas SB Jonas RA Parapapillary atrophy: histological gamma zone and delta zone. PLoS One . 2012; 7: e47237. [CrossRef] [PubMed]
Panda-Jonas S Xu L Yang H Wang YX Jonas SB Jonas JB. Optic disc morphology in young patients after antiglaucomatous filtering surgery [ published online ahead of print January 29, 2013]. Acta Ophthalmol . doi:10.1111/j.1755-3768.2012.02570.x .

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