Clinical Significance of the Location of Recurrent Optic Disc Hemorrhage in Glaucoma

Abstract

PURPOSE.To compare clinical characteristics and visual field (VF) progression between glaucomatous eyes with disc hemorrhage (DH) recurring at the same or different locations in relation to the initial DH location. METHODS.One hundred forty-seven open-angle glaucoma patients with DH who were observed for more than 4 years and had more than six VF tests were included. Disc hemorrhage that recurred at the same location as the initial DH was defined as a DH at the same location, and DH that recurred at a different location was defined as a DH at a different location. Overall rate of VF change using the mean deviation (MD) was compared between groups using a linear mixed model, and Kaplan-Meier survival analysis was performed.RESULTS. Seventy-seven (52.4%) eyes had nonrecurrent DH, and 70 (47.6%) eyes had recurrent DH detected during the follow-up period. Recurrent DH at the same location (À0.32 dB/y) was not significantly different from the nonrecurrent DH group in terms of the rate of VF change (P ¼ 0.116). However, the recurrent DH group at different locations (À1.07 dB/y) had a significantly different rate of VF change compared to the recurrent DH group at the same location (P ¼ 0.014). By Kaplan-Meier analysis, eyes with recurrent DH at different locations showed the fastest time to VF progression compared to other groups (log rank test, P < 0.001).CONCLUSIONS. Eyes with recurrent DH recurring at different locations from initial DH sites had more pronounced VF progression.

Disc haemorrhages in Polish Caucasian patients with normal tension glaucoma

“…The rate of progression observed in our study was more than twice as high as that reported by Park (Park et al. ). However, the initial MD in this study was also twice smaller than in our patients, and some studies have suggested that a baseline MD of more than −4.0 dB carried an increased risk of progression compared to an MD of less than −4.0 dB (Prata et al.…”

Optic disc hemorrhages in glaucoma and common clinical features

“…15,[59][60][61] Most studies indicate that neuroretinal rim is necessary for the development of a disc hemorrhage. 30,62,63 We found that localized nerve fibre layer loss corresponded with the hemorrhage. Studies using red-free fundus photographs from Germany 30 (35%) and Finland 8 (46%) showed more frequent RNFL defects in association with disc hemorrhages, and when evaluated by scanning laser ophthalmoscopy, approached 80%.…”

Evaluation of Ganglion Cell–Inner Plexiform Layer Thinning in Eyes With Optic Disc Hemorrhage: A Trend-Based Progression Analysis

“…progression of glaucoma. 21,30 Eyes with recurrent DH may have received intensified treatment and may have been followed up more closely. Intensifying treatment can slow the rate of RNFL thinning in eyes with DH and should be considered when interpreting the clinical significance of recurrent DH.…”

“…The method has been described in detail elsewhere. 20,21 The proximal location (cup wall, cup margin, disc rim, or disc margin), angular extent (circumferential angle formed by two lines drawn from the disc center to the two points farthest from each other circumferentially), corrected area (calculated in consideration of the magnification factors related to the SD-OCT camera and the eye by substituting the subject's axial length), and corrected length of maximum radial extent of DH (the straight distance from the center of the optic disc to the point of maximum radial extent of DH, which compensates for the magnification factor) were assessed to determine the topographic characteristics of DH. Nonrecurrent DH was defined as DH detected only once during follow-up.…”