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Editors Selection IGR 17-3

Anatomical structures: Laminar alterations and disc hemorrhage

Comment by Atusya Miki on:

56961 Recent structural alteration of the peripheral lamina cribrosa near the location of disc hemorrhage in glaucoma, Lee EJ; Kim TW; Kim M et al., Investigative Ophthalmology and Visual Science, 2014; 55: 2805-2815

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Disc hemorrhage has long been associated with both development and progression of glaucoma.¹ Nevertheless, the exact mechanism for disc hemorrhage in glaucoma is yet to be determined. In this study, Lee and colleagues proposed a possible association between disc hemorrhage and the lamina cribrosa deformation in glaucomatous eyes using enhanced depth imaging optical coherence tomography (EDI OCT). Previously, one cross-sectional study suggested a relationship between disc hemorrhage and lamina cribrosa deformation.² The authors of the current study conducted a prospective study to further clarify this potential relationship.

In 45 eyes with glaucoma, EDI OCT images taken before and after the occurrence of disc hemorrhage were compared to see whether there is any structural alteration of the lamina cribrosa. Structural alteration in this study was defined as either an outward deformation or a radial disruption of the lamina cribrosa exceeding the limit of test-retest variability. Forty out of 45 eyes with disc hemorrhage (88.9%) showed structural alteration, whereas only 11.1 % (4/36) of control eyes (glaucomatous eyes without disc hemorrhage for at least one year) did so. In addition, the largest structural alteration occurred in areas near the disc hemorrhage location in all eyes in the disc hemorrhage group. These results support the notion that disc hemorrhage and structural alteration of the lamina cribrosa occur concurrently or within a very short interval in the process of glaucomatous optic nerve damage.

Disc hemorrhage is not only a risk factor for glaucoma but is directly involved in the pathophysiology of glaucomatous optic neuropathy

This study suggests that disc hemorrhage is not only a risk factor for glaucoma but is directly involved in the pathophysiology of glaucomatous optic neuropathy. Despite several limitations the authors mentioned in the discussion, the findings of the current study is a significant step forward for the better understanding of the pathogenesis of glaucomatous optic neuropathy, as well as for the better risk profiling of glaucoma.

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