June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Drance hemes imaged by indirect AOSLO show axonal bundle changes
Author Affiliations & Notes
  • Thomas Gast
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Brett King
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Kaitlyn Anne Sapoznik
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Brittany R Walker
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Leslie Collins
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Stephen A Burns
    indiana unv school of optometry, Bloomington, Indiana, United States
  • Footnotes
    Commercial Relationships   Thomas Gast, None; Brett King, None; Kaitlyn Sapoznik, None; Brittany Walker, None; Leslie Collins, None; Stephen Burns, None
  • Footnotes
    Support  EYO 24315
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3920. doi:
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    • Get Citation

      Thomas Gast, Brett King, Kaitlyn Anne Sapoznik, Brittany R Walker, Leslie Collins, Stephen A Burns; Drance hemes imaged by indirect AOSLO show axonal bundle changes. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3920.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Drance hemes are small hemorrhages adjacent to the optic disk seen in glaucoma patients. The presence of these hemorrhages are clinically associated with the existence and progression of glaucoma. The pathophysiology of this process and its linkage to glaucoma have been unclear. We have attempted to understand this entity via imaging of these hemorrhages, the disk and nerve fiber layer (NFL) around them, as well as the retinal NFL which passes through the area of the Drance hemorrhage.

Methods : A total of 10 glaucoma patients with 12 newly discovered Drance hemorrhages were referred from our disease clinic for imaging with AOSLO, OCT, and OCTA. These patients were imaged from 1 to 16 times. The patients were 7 females and 3 males with an average age of 68.6 yrs, (SD= 8.4). At each visit OCTs, an OCTA, as well as AOSLO of the area of the Drance hemorrhage, the surrounding disk rim, the nerve fiber layer over and around the hemorrhage, as well as the path of those nerve bundles along the retina were done. If time allowed, a similar area of the retinal nerve fiber layer reflected across the horizontal meridian was imaged as within patient control. The dimensions of the hemorrhage, the appearance of the nerve fiber layer in this area, the relationship to the pre-existing NFL defects, and the presence or absence of small cyst-like structures seen only on the indirect channel of AOSLO were noted on each visit.

Results : The primary result is that the NFL within and around the Drance hemorrhage was swollen and irregular (Fig 1). This finding was apparent in 9 of the10 patients (90%). The hemorrhages were measured along their length (along the NFL), and breadth. The averages were 358(L) and 201(B) microns. Most of the hemorrhages were located at the edge of a prior NFL defect (83%).The small cysts (Fig 2), thought to be apoptotic ganglion cells, were present along the path of the NFL in 91% of the hemes successfully imaged (11/12).. In those patients imaged longitudinally, the hemorrhage cleared while the NFL abnormalities persisted at the retinal site of the hemorrhage.

Conclusions : Through the imaging of Drance hemorrhages with direct and indirect AOSLO, abnormalities in the NFL over and around the hemorrhages as well as apoptotic cells along the NFL path were seen. This study provides a direct association between the clinical entity of Drance hemorrhages and the progression of NFL loss seen in some glaucoma patients.

This is a 2020 ARVO Annual Meeting abstract.

 

 

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