Features of the Lamina Cribrosa and the Autonomic Nervous System in Glaucoma Patients with Disc Hemorrhages

Jinu Kim; Chan Kee Park; Hae-Young Lopilly Park

doi:10.3341/jkos.2018.59.4.355

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Kim, Park, and Park: Features of the Lamina Cribrosa and the Autonomic Nervous System in Glaucoma Patients with Disc Hemorrhages

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(4): 355-361.

Published online: 16 April 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.355

Features of the Lamina Cribrosa and the Autonomic Nervous System in Glaucoma Patients with Disc Hemorrhages

Jinu Kim, MD, Chan Kee Park, MD, PhD, Hae-Young Lopilly Park, MD, PhD

Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to Hae-Young Lopilly Park, MD, PhD. Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: 82-2-2258-6329, Fax: 82-2-599-7405, lopilly@hanmail.net

Received 24 August 2017 Revised 11 January 2018 Accepted 22 March 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the effects of structural changes in the lamina cribrosa (LC) and the status of the autonomic nervous system on disc hemorrhages (DHs).

Methods

A retrospective study was performed on 68 eyes of 68 patients with primary open-angle glaucoma and optic DHs. We divided the patients into two groups using optical coherence tomography according to the presence of LC defects, and then compared both groups. We also analyzed autonomic nervous system function using the heart rate variability test, and compared the two groups.

Results

Eyes with LC defects had significantly longer axial lengths than those without defects (p = 0.029), and the DH was located more proximally (p < 0.001). A significantly larger proportion of eyes without LC defects had configurational optic disc changes such as optic disc rim notching, focal rim thinning, or generalized thinning (p = 0.001). On heart rate variability testing, the group without LC defects had a significantly higher “low frequency/high frequency ratio” than the group with defects (p = 0.008).

Conclusions

There was a difference in the clinical features of DH between eyes with and without LC defects. Eyes with LC defects were more myopic and the proximal part of the DH tended to be on the disc cup or characterized by peripapillary atrophy. These results suggest that the DH developed due to a mechanical cause in eyes with LC defects. Patients without LC defects had a more dysregulated autonomic nervous system. The DH location was related to disc rim notching and neural rim losses, which implies ischemia as the pathogenic mechanism involved in the development of DH in eyes without LC defects. Therefore, more careful observations of the LC would facilitate a better understanding of the specific pathogenic mechanisms underlying DH.

Keywords: Disc hemorrhage, Glaucoma, Heart rate variability, Lamina cribrosa

Figures and Tables

Table 1

Characteristics of open-angle glaucoma patients with single or recurrent disc hemorrhage during follow-up periods

Values are presented as mean ± SD unless otherwise indicated.

LC = lamina cribrosa; RNFL = retinal nerve fiber layer; VF = visual field; DH = disc hemorrhage.

^*Student's t-test; ^†Chi-square test.

Table 2

Characteristics of open-angle glaucoma patients with single or recurrent disc hemorrhage during follow-up periods

Values are presented as n (%) unless otherwise indicated.

LC = lamina cribrosa.

^*Fisher's exact test.

Table 3

Characteristics of open-angle glaucoma patients with single or recurrent disc hemorrhage during follow-up periods

Values are presented as mean ± SD unless otherwise indicated.

LC = lamina cribrosa; BP = blood pressure; HR = heart rate; SDNN = standard deviation of the NN intervals; TP = total power; VLF = very low frequency power; LF = low frequency power; HF = high frequency power.

^*Student's t-test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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