Possible Extension of Inner Scleral Fibers Into the Peripapillary Sclera Detected by Polarization-Sensitive OCT

Purpose: To determine the structural characteristics of the peripapillary sclera in myopic eyes using polarization-sensitive optical coherence tomography (PS-OCT). Methods: Patients with myopia who underwent PS-OCT imaging between April and June of 2023 were studied. The intensity, optic axis, and birefringence of the PS-OCT images were analyzed to determine the configuration of the lamina cribrosa (LC). The direction and arrangement of the scleral collagen fibers in the peripapillary region and scleral ridge were determined. Results: In total, 110 eyes of 59 patients with myopia (mean axial length, 30.00 ± 1.98 mm) were studied. PS-OCT showed that the scleral fibers around the optic nerve were arranged circularly in all eyes, regardless of the presence or size of the peripapillary atrophy. Inner scleral fibers that appeared to penetrate beneath this circular arrangement were detected in 94 eyes (85.5%). There was a Y-shaped split at the point of penetration in 77 eyes (70.0%). The integrity of the circular arrangement and possible presence of penetrating scleral fiber complexes remained intact, even in cases of severe peripapillary scleral deformation. A scleral ridge was identified in 27 eyes (24.5%), and it appeared as a full-thickness protrusion composed primarily of outer scleral fibers. The ridge was consistently located outside the circular arrangement. Conclusions: PS-OCT imaging suggests the possible presence of inner scleral fibers penetrating the peripapillary circular scleral arrangement. These fibers may contribute to peripapillary structural stability and potentially extend toward the LC.