Schnabel cavernous degeneration: a vascular change of the aging eye

Schnabel cavernous degeneration is a histologic finding originally attributed to glaucoma; however, its cause and significance have been controversial. To determine the basic cause of the formation of cavernous spaces in the proximal optic nerve and its clinical significance. A retrospective analysis of 4500 autopsy eyes processed for histologic evaluation between 1967 and 1991. Ninety-three (2.1% of eyes examined) cases of Schnabel cavernous optic atrophy were identified. The majority of the eyes were from women (81%). The mean age of the entire group was 88 years (reference range, 54-103 years). Severe vascular anomalies were present in 75% of the individuals. Cavernous degeneration was unilateral in 82% of the cases. Loss of ganglion cells and nerve fiber layer consistent with glaucoma was found in 23.7% of the individuals. Clinical information was available for 15 individuals (16%). Half of them were thought to have some clinical optic nerve damage; in the remainder, no specific optic disc abnormalities were noted. Histologic findings of arteriolosclerosis in the optic nerve circulation were common. The prevalence of glaucoma was low. Schnabel cavernous optic atrophy appears to be a unilateral condition of elderly women with systemic vascular disease and few characteristic ocular features. Our data indicate that a chronic vascular occlusive disease of the proximal optic nerve is more involved in cavernous atrophic pathogenesis than is a sustained increase of intraocular pressure.