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A novel hypothesis for the pathogenesis of glaucomatous disc hemorrhage
Progress in Retinal and Eye Research ( IF 18.6 ) Pub Date : 2017-08-30 , DOI: 10.1016/j.preteyeres.2017.08.002
Eun Jung Lee , Jong Chul Han , Changwon Kee

Disc hemorrhage is known to be associated with glaucoma development and progression. Several hypotheses have been proposed to explain the pathogenesis of disc hemorrhage in glaucoma, including mechanical and ischemic theories. However, no theory has yet provided a clear explanation of cellular-level events and related histologic findings. Moreover, research has yet to elucidate why glaucomatous disc hemorrhage occurs around the optic disc and at the margin of the retinal nerve fiber layer defect. Understanding the pathogenic mechanism of disc hemorrhage will facilitate interpretation of its clinical importance, and provide better insight into clinical practice. In this review, we sought to provide a plausible hypothesis for the development of glaucomatous disc hemorrhage that could explain the aforementioned characteristic features. We suggest a new and detailed mechanism for disc hemorrhage. Critical microscopic events are also discussed in relation to reactive gliosis in glaucoma. With proliferative reactive gliosis, fibrous glial scar forms, and we suggest that the traction force induced by glial scar formation might disrupt capillary at the border between the healthy and damaged retinal nerve fiber layer, and develop splinter-shaped peripapillary hemorrhage. In addition to glial scar formation, remodeling and deformation of lamina cribrosa beams would insult the capillary surrounding the pore of the lamina cribrosa, and lead to development of round blotch-shaped cup hemorrhage. Histopathologic confirmation of these findings should be explored in future investigations.



中文翻译:

青光眼椎间盘出血发病机制的新假说

椎间盘出血已知与青光眼的发生和发展有关。已经提出了几种假说来解释青光眼椎间盘出血的发病机理,包括机械学说和缺血学说。然而,尚无理论提供细胞水平事件和相关组织学发现的明确解释。此外,研究尚未阐明为什么青光眼椎间盘出血发生在视盘周围和视网膜神经纤维层缺损的边缘。了解椎间盘出血的病因机制将有助于解释其临床重要性,并为临床实践提供更好的见解。在这篇综述中,我们试图为青光眼椎间盘出血的发展提供一个合理的假设,该假说可以解释上述特征。我们建议一种新的详细的椎间盘出血机制。还讨论了与青光眼的反应性神经胶质增生有关的重要的微观事件。随着增生性反应性神经胶质增生,纤维性神经胶质瘢痕形成,我们建议由神经胶质瘢痕形成引起的牵引力可能会破坏健康与受损的视网膜神经纤维层之间的边界处的毛细血管,并形成碎片状的乳头状周围性大出血。除形成神经胶质疤痕外,筛板光束的重塑和变形还会侮辱筛板孔周围的毛细血管,并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。还讨论了与青光眼的反应性神经胶质增生有关的重要的微观事件。随着增生性反应性神经胶质增生,纤维性神经胶质瘢痕形成,我们建议由神经胶质瘢痕形成引起的牵引力可能会破坏健康与受损的视网膜神经纤维层之间的边界处的毛细血管,并形成碎片状的乳头状周围性大出血。除形成神经胶质疤痕外,筛板光束的重塑和变形还会侮辱筛板孔周围的毛细血管,并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。还讨论了与青光眼的反应性神经胶质增生有关的重要的微观事件。随着增生性反应性神经胶质增生,纤维性神经胶质瘢痕形成,我们建议由神经胶质瘢痕形成引起的牵引力可能会破坏健康与受损的视网膜神经纤维层之间的边界处的毛细血管,并形成碎片状的乳头状周围性大出血。除形成神经胶质疤痕外,筛板光束的重塑和变形还会侮辱筛板孔周围的毛细血管,并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。我们认为,由胶质瘢痕形成引起的牵引力可能会破坏健康与受损的视网膜神经纤维层之间的边界处的毛细血管,并产生碎片状的乳头状周围性大出血。除形成神经胶质疤痕外,筛板光束的重塑和变形还会侮辱筛板孔周围的毛细血管,并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。我们认为,由胶质瘢痕形成引起的牵引力可能会破坏健康与受损的视网膜神经纤维层之间的边界处的毛细血管,并产生碎片状的乳头状周围性大出血。除形成神经胶质疤痕外,筛板光束的重塑和变形还会侮辱筛板孔周围的毛细血管,并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。并导致圆形斑点状杯状出血的发展。这些发现的组织病理学证实应在以后的研究中探讨。

更新日期:2017-08-30
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