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Editors Selection IGR 14-4

Bloodflow: PP retinal flow and disc hemorrhages

Comment by Leopold Schmetterer on:

26576 Altered temporal peripapillary retinal flow in patients with disc hemorrhages, Kurvinen L; Harju M; Saari J et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2010; 248: 1771-1775

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Optic disc hemorrhages are associated with progression of glaucoma. The pathophysiology of this phenomenon is incompletely understood. Kurvinen et al. (1217) studied 21 eyes of 21 patients with unilateral disk hemorrhages. A subgroup of the study population had glaucoma (n = 14). Measurements of blood flow in the peripapillary retina were done by scanning laser Doppler flowmetry at the time of disk hemorrhage diagnosis and 6 months later. Four temporal areas were defined for measurements and an automatic full-field perfusion image analysis (AFFPIA, Heidelberg Engineering) was performed.

Scanning laser Doppler flowmetry has 'limited reproducibility' and 'is not capable of providing absolute blood flow values

When the authors averaged data from the four areas of interest an increase in mean flow in the peripapillary retina was observed after six months. The present study provides preliminary data that retinal perfusion is reduced during the presence of disk hemorrhages. Several limitations including the small number of subjects and the heterogeneity of the glaucoma group (primary open-angle glaucoma, normal tension glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma) need to be considered. In addition, the limitations of scanning laser Doppler flowmetry need to be taken into account, particularly the limited reproducibility and the fact that the system is not capable of providing absolute blood flow values. The concept that ocular perfusion is, reduced during the appearance of optic disc hemorrhages is, however, interesting and deserves further investigation.

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