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Optic disc hemorrhage is related to various hemodynamic findings by disc angiography.

Park HY, Jeong HJ, Kim YH, Park CK - PLoS ONE (2015)

Bottom Line: Prevalence of DH and location of the proximal border were recorded from disc photographs.Arm-retina time, arteriovenous transit time, disc filling time, choroidal filling time, and venous filling time were measured as retinal circulation parameters.These findings suggest that vascular and hemodynamic changes due to glaucomatous structural changes cause DH in relation to localized RNFL defects.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background: To investigate the hemodynamic characteristics of glaucoma eyes with disc hemorrhage (DH) by disc fluorescein angiography, and its relationship with glaucomatous changes of the optic disc and surrounding retinal nerve fiber layer (RNFL).

Methods: This study included 35 glaucoma eyes with DH who were followed up at least 5 years and had DH at presentation. Eyes were classified as eyes with DH at the border of localized RNFL defects and eyes with DH not related to localized RNFL defects. Prevalence of DH and location of the proximal border were recorded from disc photographs. Fluorescein angiography was performed 3 months after detecting the DH. Arm-retina time, arteriovenous transit time, disc filling time, choroidal filling time, and venous filling time were measured as retinal circulation parameters. The presence of disc filling defects and disc leaks were evaluated.

Results: There were 19 (54.3%) eyes with DH accompanying localized RNFL defects. The arm-retina time was prolonged in eyes with DH not related to RNFL defects (P = 0.044) and the arteriovenous transit time was prolonged in eyes with DH accompanying RNFL defects (P = 0.029). Among eyes with DH accompanying RNFL defects, 11 (57.9%) had vessel filling defects or delayed filling indicating blood flow stasis at the cup margin proximal to where DH occurred. Eyes with DH not related to RNFL defects did not show vessel filling defects or delayed filling.

Conclusions and relevance: Eyes with DH related to RNFL defects showed prolonged arteriovenous transit time and had frequent vessel filling defects or delayed filling indicating blood flow stasis and thrombus formation at the site DH occurred. These findings suggest that vascular and hemodynamic changes due to glaucomatous structural changes cause DH in relation to localized RNFL defects.

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Fluorescein angiography of normal control eye (A) and glaucoma eyes with disc hemorrhage (DH) (B and C).The angiography of normal control eye was from a patient who underwent this examination due to unknown blurred vision (this case is not included in the analysis of the present study, however, is added in this figure to help comparison with glaucoma eyes). Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (arrowhead in A-1, B-1, C-1) and entrance into the vein (arrowhead in A-2, B-2, C-2) from a distance of 2 optic discs. Glaucomatous eye with DH occurring at the border of localized retinal nerve fiber layer (RNFL) defect (B’ and B”; localized RNFL defect, arrowhead in B’) shows prolonged arteriovenous transit time (time interval between B-1, when fluorescein dye is introduced into the artery, and B-2, when fluorescein dye enters the vein from a distance of 2 optic discs) (delayed by 3 seconds). Glaucomatous eye with DH occurring at the 6 o’clock position not related to a localized RNFL defect (C’ and C”) shows prolonged arm-retina time, which is the time from the administration of fluorescein dye to the antecubital vein until it becomes visible in the retinal arteries (C-1, 23 seconds).
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pone.0120000.g001: Fluorescein angiography of normal control eye (A) and glaucoma eyes with disc hemorrhage (DH) (B and C).The angiography of normal control eye was from a patient who underwent this examination due to unknown blurred vision (this case is not included in the analysis of the present study, however, is added in this figure to help comparison with glaucoma eyes). Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (arrowhead in A-1, B-1, C-1) and entrance into the vein (arrowhead in A-2, B-2, C-2) from a distance of 2 optic discs. Glaucomatous eye with DH occurring at the border of localized retinal nerve fiber layer (RNFL) defect (B’ and B”; localized RNFL defect, arrowhead in B’) shows prolonged arteriovenous transit time (time interval between B-1, when fluorescein dye is introduced into the artery, and B-2, when fluorescein dye enters the vein from a distance of 2 optic discs) (delayed by 3 seconds). Glaucomatous eye with DH occurring at the 6 o’clock position not related to a localized RNFL defect (C’ and C”) shows prolonged arm-retina time, which is the time from the administration of fluorescein dye to the antecubital vein until it becomes visible in the retinal arteries (C-1, 23 seconds).

Mentions: The disc filling time, choroidal filling time, venous filling time, and frequency of disc leak were not different between eyes with DHs accompanying RNFL defects and eyes with DHs not related to RNFL defects (Table 3). However, arm-retina time was prolonged in eyes with DHs not related to RNFL defects (22.36 ± 5.66 seconds) compared to eyes with DHs related to RNFL defects (19.63 ± 3.63 seconds, P = 0.044). The arteriovenous transit time was prolonged in eyes with DH accompanying a RNFL defect (2.79 ± 1.72 seconds) compared to eyes with a DH not related to RNFL defect (1.79 ± 0.93 seconds, P = 0.029). The presence of a disc filling defect showed borderline significance between eyes with DHs accompanying RNFL defects (47.4%) and eyes with DHs not related to RNFL defects (18.8%, P = 0.077; Table 3). Representative cases are shown in Fig 1. Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (Fig 1, A-1; B-1; C-1) and entrance into the vein (Fig 1, A-2; B-2; C-2) from a distance of 2 optic discs. This was delayed to approximately 3 seconds in eyes with DH at the border of a localized RNFL defect (Fig 1, B’ and B”). Arm-retina time is the time from the administration of an opaque substance into the antecubital vein until it becomes visible in the retinal arteries (Fig 1, A-1; B-1; C-1). This was delayed to 23 seconds (Fig 1, C-1) in eyes with DH not related to a RNFL defect (Fig 1, C’ and C”) compared to normal controls (Fig 1, A-1, 15 seconds) and eyes with DH accompanying a RNFL defect (Fig 1, B-1, 19 seconds). At 29 seconds, almost all arteries and veins were filled with opaque substance in normal controls (Fig 1, A-3). However, just the arteries and a few veins were filled with opaque substance at around 27 and 30 seconds, respectively, in glaucomatous eyes with DH (Fig 1, B-3 and C-3).


Optic disc hemorrhage is related to various hemodynamic findings by disc angiography.

Park HY, Jeong HJ, Kim YH, Park CK - PLoS ONE (2015)

Fluorescein angiography of normal control eye (A) and glaucoma eyes with disc hemorrhage (DH) (B and C).The angiography of normal control eye was from a patient who underwent this examination due to unknown blurred vision (this case is not included in the analysis of the present study, however, is added in this figure to help comparison with glaucoma eyes). Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (arrowhead in A-1, B-1, C-1) and entrance into the vein (arrowhead in A-2, B-2, C-2) from a distance of 2 optic discs. Glaucomatous eye with DH occurring at the border of localized retinal nerve fiber layer (RNFL) defect (B’ and B”; localized RNFL defect, arrowhead in B’) shows prolonged arteriovenous transit time (time interval between B-1, when fluorescein dye is introduced into the artery, and B-2, when fluorescein dye enters the vein from a distance of 2 optic discs) (delayed by 3 seconds). Glaucomatous eye with DH occurring at the 6 o’clock position not related to a localized RNFL defect (C’ and C”) shows prolonged arm-retina time, which is the time from the administration of fluorescein dye to the antecubital vein until it becomes visible in the retinal arteries (C-1, 23 seconds).
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pone.0120000.g001: Fluorescein angiography of normal control eye (A) and glaucoma eyes with disc hemorrhage (DH) (B and C).The angiography of normal control eye was from a patient who underwent this examination due to unknown blurred vision (this case is not included in the analysis of the present study, however, is added in this figure to help comparison with glaucoma eyes). Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (arrowhead in A-1, B-1, C-1) and entrance into the vein (arrowhead in A-2, B-2, C-2) from a distance of 2 optic discs. Glaucomatous eye with DH occurring at the border of localized retinal nerve fiber layer (RNFL) defect (B’ and B”; localized RNFL defect, arrowhead in B’) shows prolonged arteriovenous transit time (time interval between B-1, when fluorescein dye is introduced into the artery, and B-2, when fluorescein dye enters the vein from a distance of 2 optic discs) (delayed by 3 seconds). Glaucomatous eye with DH occurring at the 6 o’clock position not related to a localized RNFL defect (C’ and C”) shows prolonged arm-retina time, which is the time from the administration of fluorescein dye to the antecubital vein until it becomes visible in the retinal arteries (C-1, 23 seconds).
Mentions: The disc filling time, choroidal filling time, venous filling time, and frequency of disc leak were not different between eyes with DHs accompanying RNFL defects and eyes with DHs not related to RNFL defects (Table 3). However, arm-retina time was prolonged in eyes with DHs not related to RNFL defects (22.36 ± 5.66 seconds) compared to eyes with DHs related to RNFL defects (19.63 ± 3.63 seconds, P = 0.044). The arteriovenous transit time was prolonged in eyes with DH accompanying a RNFL defect (2.79 ± 1.72 seconds) compared to eyes with a DH not related to RNFL defect (1.79 ± 0.93 seconds, P = 0.029). The presence of a disc filling defect showed borderline significance between eyes with DHs accompanying RNFL defects (47.4%) and eyes with DHs not related to RNFL defects (18.8%, P = 0.077; Table 3). Representative cases are shown in Fig 1. Arteriovenous transit time is the time between the entrance of the opaque substance into the retinal artery (Fig 1, A-1; B-1; C-1) and entrance into the vein (Fig 1, A-2; B-2; C-2) from a distance of 2 optic discs. This was delayed to approximately 3 seconds in eyes with DH at the border of a localized RNFL defect (Fig 1, B’ and B”). Arm-retina time is the time from the administration of an opaque substance into the antecubital vein until it becomes visible in the retinal arteries (Fig 1, A-1; B-1; C-1). This was delayed to 23 seconds (Fig 1, C-1) in eyes with DH not related to a RNFL defect (Fig 1, C’ and C”) compared to normal controls (Fig 1, A-1, 15 seconds) and eyes with DH accompanying a RNFL defect (Fig 1, B-1, 19 seconds). At 29 seconds, almost all arteries and veins were filled with opaque substance in normal controls (Fig 1, A-3). However, just the arteries and a few veins were filled with opaque substance at around 27 and 30 seconds, respectively, in glaucomatous eyes with DH (Fig 1, B-3 and C-3).

Bottom Line: Prevalence of DH and location of the proximal border were recorded from disc photographs.Arm-retina time, arteriovenous transit time, disc filling time, choroidal filling time, and venous filling time were measured as retinal circulation parameters.These findings suggest that vascular and hemodynamic changes due to glaucomatous structural changes cause DH in relation to localized RNFL defects.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background: To investigate the hemodynamic characteristics of glaucoma eyes with disc hemorrhage (DH) by disc fluorescein angiography, and its relationship with glaucomatous changes of the optic disc and surrounding retinal nerve fiber layer (RNFL).

Methods: This study included 35 glaucoma eyes with DH who were followed up at least 5 years and had DH at presentation. Eyes were classified as eyes with DH at the border of localized RNFL defects and eyes with DH not related to localized RNFL defects. Prevalence of DH and location of the proximal border were recorded from disc photographs. Fluorescein angiography was performed 3 months after detecting the DH. Arm-retina time, arteriovenous transit time, disc filling time, choroidal filling time, and venous filling time were measured as retinal circulation parameters. The presence of disc filling defects and disc leaks were evaluated.

Results: There were 19 (54.3%) eyes with DH accompanying localized RNFL defects. The arm-retina time was prolonged in eyes with DH not related to RNFL defects (P = 0.044) and the arteriovenous transit time was prolonged in eyes with DH accompanying RNFL defects (P = 0.029). Among eyes with DH accompanying RNFL defects, 11 (57.9%) had vessel filling defects or delayed filling indicating blood flow stasis at the cup margin proximal to where DH occurred. Eyes with DH not related to RNFL defects did not show vessel filling defects or delayed filling.

Conclusions and relevance: Eyes with DH related to RNFL defects showed prolonged arteriovenous transit time and had frequent vessel filling defects or delayed filling indicating blood flow stasis and thrombus formation at the site DH occurred. These findings suggest that vascular and hemodynamic changes due to glaucomatous structural changes cause DH in relation to localized RNFL defects.

Show MeSH
Related in: MedlinePlus