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II. The Site of Injury and Susceptibility to Damage

Harry A. Quigley, MD; Earl M. Addicks; W. Richard Green, MD; A. E. Maumenee, MD

Arch Ophthalmol. 1981;99(4):635-649.

Abstract
• We examined the histologic structure of the optic nerve head in 15 eyes of nine persons with a known glaucoma history. All had been seeing eyes, varying from normal visual acuity and visual field to advanced glaucoma damage. The site of damage to nerve fibers is the scleral lamina cribrosa, where there is local blockage of axonal transport. Early cup size increase prior to definite field loss results from loss of nerve fibers, not from damage to astrocytic glial cells of the nerve head. No selective damage to nerve head capillaries is seen in mildly damaged specimens. Scanning electron microscopic analysis suggests that the structure of the lamina cribrosa is an important determinant of the degree of susceptibility to damage by elevated intraocular pressure.

Author Affiliations
From the Glaucoma Service and Eye Pathology Laboratory, Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore.

Footnotes
Accepted for publication Sept 29, 1980.

Read in part at the 1980 meeting of the Association for Research in Vision and Ophthalmology, Orlando, Fla, May 9, 1980.

Reprint requests to Wilmer B-2, The Johns Hopkins Hospital, Baltimore, MD 21205 (Dr Quigley).

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