Splinter (drance) hemorrhages associated with NTG primarily occur in which retinal layer?

• A. RNFL near the optic disc
• B. Inner nuclear layer
• C. Outer plexiform layer
• D. Ganglion cell layer

Answer: (A)

Splinter (Drance) hemorrhages in normal-tension glaucoma come from the superficial networks of the retinal nerve fiber layer that surround the optic disc. They appear as slender, flame- or splinter-shaped hemorrhages aligned with the nerve fiber bundles in the peripapillary RNFL. The RNFL near the optic disc is where the axons and their superficial capillaries are most vulnerable to glaucoma-related stress and perfusion changes, so hemorrhages occur here rather than in deeper retinal layers. The inner nuclear layer, outer plexiform layer, and ganglion cell layer are deeper or different tissue layers where these surface flame-like hemorrhages are not typically found.