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对青光眼眼盘出血发病机制的一个新的假设

Lee, E.J., Han, J.C., Kee, C.

期刊名称:Progress in Retinal and Eye Research

卷期:2017年第60卷

摘要

摘要:已知视盘出血与青光眼发展和进展相关。已经有几个假设来解释青光眼视盘出血的发病机制,包括机械和缺血理论。然而,没有任何理论能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性视盘出血发生在视盘周围和视网膜神经纤维层缺损边缘。了解视盘出血的致病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理解。在本篇综述中,我们试图为青光眼性视盘出血提供一个合理的假设,以解释上述特征。我们发现了种新型、详细的视盘出血机制。关于青光眼的反应性胶质增生,我们还讨论了关键的微观事件。随着增殖反应性胶质增生,纤维状胶质细胞形成,我们认为由神经胶质瘢痕形成引起的牵引力可能会破坏健康和受损的视网膜神经纤维层之间的边界处的毛细血管,并发展为碎片状的边缘性毛细血管出血。除了胶质瘢痕形成之外,筛板骨折的重塑和变形会损害围绕筛板周围的毛细血管,并导致圆形斑点状出血。这些组织病理学确认结果的发现应在今后的调查中探讨。

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.


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