Ocular and systemic risk factors associated with recurrent disc hemorrhage in primary open-angle glaucoma

Abstract

PurposeTo evaluate the risk factors associated with recurrent disc hemorrhage (DH), defined for the present study as at least 3 occurrences of DH in primary open-angle glaucoma (POAG).MethodsA total of 178 POAG patients (89 eyes showing at least 3 occurrences of DH and 89 age-matched control eyes with a minimum of 10 years’ follow-up without DH) were included in a retrospective, case-control study. Ocular factors were evaluated by a retrospective chart review, and systemic factors were evaluated by a telephone survey. Associations between factors and recurrent DH were investigated by logistic regression analysis. The Kaplan–Meier survival analysis and Cox proportional-hazards regression models were used to evaluate glaucoma progression and to identify the factors predictive of glaucoma progression.ResultsUnivariate regression analysis revealed the association of recurrent DH with low baseline intraocular pressure (IOP) [odds ratio (OR), 0.88; 95% confidential interval (CI), 0.80–0.98; P = 0.014], lower percentage reduction of IOP (OR, 0.96; 95% CI, 0.93–0.99; P = 0.020), cold extremities (OR, 2.80; 95% CI, 1.03–7.60; P = 0.043), prone or lateral decubitus sleeping position (OR, 2.14; 95% CI, 1.13–4.03; P = 0.019), and sleeping disorders (OR, 2.33; 95% CI, 1.05–5.15; P = 0.037). Multivariate regression analysis revealed that a lower percentage reduction in IOP (OR, 0.96; 95% CI, 0.93–1.00; P = 0.046) increased the risk of recurrent DH. The control group exhibited a greater cumulative probability of non-progression than the recurrent DH group (P = 0.01, by log-rank test). The Cox proportional-hazards regression model showed that recurrent DH was associated with glaucoma progression [hazard ratio (HR), 1.88; 95% CI; 1.66–3.05; P = 0.01.ConclusionsAmong the ocular and systemic factors, only lower-percentage reduction of IOP in POAG was associated with recurrent DH. DH recurrence is associated with glaucoma progression and may be dependent on IOP.

Association between Glaucoma Progression in Macular Ganglion Cell Complex and Disc Hemorrhage: Differences between Superior and Inferior Hemiretinas

“…The no-DH group might have included patients with undetected DHs, considering the short duration of DH [ 39 ]. However, the interval of three months for DH observation in this study is comparable to that adopted in other studies on DHs [ 11 , 14 , 15 , 16 , 17 , 18 , 20 , 22 , 24 , 29 , 32 , 33 , 34 , 36 , 37 , 38 ]. Although we did not examine the association between DH and systemic diseases or drug usage, systemic hypertension [ 19 , 21 ], diabetes [ 19 , 45 ] and use of aspirin [ 45 ] were reported to be significantly associated with DH occurrence.…”

“…The influence of DH was evaluated using two variables: (1) a categorical variable of the presence or absence of DH and (2) a numerical variable of the number of visits with DH. Many studies have examined the significance of DH recurrence in the progression of glaucoma and have reported conflicting results [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Given that most DHs last at least 4 weeks and only one-third of them persist for 12 weeks or more [ 39 ], even studies with frequent follow-up visits of 3 months may miss approximately one-half of the DHs [ 38 ].…”

Vascular insufficiency leading to recurrent disc haemorrhage in normotensive glaucoma

“…It is a sign of progressive damage of the RNFL 3 DH can be caused not only by ischemic microinfarction in the optic disc, but also by mechanical rupture of small blood vessels arising from structural changes at the level of the lamina cribrosa. 4 Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that pre perimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or pre perimetric RNFL loss in the eyes with DH.…”