Role of axoplasmic transport in the pathophysiology of ischaemic disc swelling.

Pathological changes in the optic disc and anterior part of the optic nerve of monkeys were studied 5 hours and several days after occlusion of the temporal short posterior ciliary arteries. Ischaemic vacuolation of neural tissue was observed in some of the animals studied and was restricted to the lamina cribrosa and the immediately retrolaminar portion of the optic nerve. Axonal swelling and organelle aggregation were demonstrated in the prelaminar region, and autoradiography after intravitreal injection of tritiated leucine revealed an associated obstruction of rapid and slow orthograde axoplasmic transport. The experimental findings correlate with those seen clinically in acute ischaemic optic neuropathy. The pale swelling of the optic disc in this condition represents an accumulation of axoplasmic debris in retinal ganglion-cell axons owing to obstruction of axoplasmic transport at the lamina cribrosa; it is thus equivalent to a 'cotton-wool spot' of the disc.