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시신경유두출혈을 보이는 녹내장 환자의 전신적인 자율신경계 상태와 사상판 소견에 대한 연구

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

대한안과학회지 2018년 59권 4호 p.355 ~ 361
김진우 ( Kim Jin-U ) - 가톨릭대학교 의과대학 서울성모병원 안과학교실

박찬기 ( Park Chan-Kee ) - 가톨릭대학교 의과대학 서울성모병원 안과학교실
박혜영 ( Park Hae-Young ) - 가톨릭대학교 의과대학 서울성모병원 안과학교실

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.

키워드

Disc hemorrhage; Glaucoma; Heart rate variability; Lamina cribrosa
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