title: Peripapillary gamma zone pit as dehiscence between Elschnig´s border tissue and Bruch´s membrane with herniation and defect of the retinal nerve fiber layer.
abstract: BACKGROUND
  The parapapillary gamma zone has recently been defined as the parapapillary region free of Bruch's membrane. Although it has been reported the presence of defects in peripapillary gamma zone, hitherto undescribed is the herniation of the retinal nerve fiver layer tissue into the peripapillary gamma zone defect with the resulting localized defects in the retinal nerve fiber layer.
  
  
  METHODS
  Ophthalmoscopy in a 36-year-old man revealed a localized defect of the retinal nerve fiber layer associated with a yellowish-gray lesion at the inferior temporal outer margin of a peripapillary gamma zone. Enhanced depth imaging of spectral-domain optical coherence tomography (OCT) showed a dehiscence at the connecting point between the central end of Bruch's membrane and the peripheral end of the border tissue of Elschnig and Jacoby. Retinal nerve fiber layer tissue was herniated through this defect into a cavitation located in the suprachoroidal space and the space above the cerebrospinal fluid space. At a 2-year follow-up examination, the defect and retinal nerve fiber layer defect appeared unchanged.
  
  
  CONCLUSIONS
  We present a peripapillary gamma zone pit originating as a dehiscence between Elschnig's border tissue and Bruch's membrane and associated with a herniation and defect of the retinal nerve fiber layer and with a suprachoroidal cavitation.
authors: Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.|Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 20031, China.
authors: Xinxin
authors: X
authors: Hu
authors: Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China. ydai@fudan.edu.cn.|Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 20031, China. ydai@fudan.edu.cn.
authors: Yi
authors: Y
authors: Dai
authors: Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany.
authors: Jost
authors: J
authors: Jonas
authors: Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.|Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, 20031, China.
authors: Xinghuai
authors: X
authors: Sun
mesh_terms: D000328:Adult; D016570:Bruch Membrane / Q000473:pathology*; D015862:Choroid Diseases / Q000473:pathology*; D006801:Humans; D008297:Male; D009216:Myopia / Q000473:pathology*; D009412:Nerve Fibers / Q000473:pathology*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D041623:Tomography, Optical Coherence
keywords: Case report; Gamma zone pit; Myopia; Peripapillary atrophy; Retinal nerve fiber layer defect; Suprachoroidal cavitation