COMMENTARY

Optic Disc Hemorrhage in Patients With Angle-Closure Glaucoma

Rod Foroozan, MD

Disclosures

October 01, 2008

Introduction

Hemorrhage along the surface of the optic disc in patients with glaucoma has traditionally been viewed as a poor prognostic sign, as well as a marker of progression of the optic neuropathy.[1] Disc hemorrhages have been thought to be more common in low-tension glaucoma; however, the prevalence of disc hemorrhage in patients with primary angle-closure glaucoma (PACG) has not been characterized as well as in primary open-angle glaucoma. The others of this retrospective, noncomparative case series reviewed the records of patients with PACG to determine the location, number of episodes, and duration of disc hemorrhage. In addition, they compared the intraocular pressure (IOP) and cup-to-disc ratio in eyes with and fellow eyes without hemorrhage.

Characteristics of Disc Hemorrhage in Primary Angle-Closure Glaucoma

Lan YW, Wang IJ, Hsiao YC, Sun FJ, Hsieh JW
Ophthalmology. 2008;115:1328-1333

The authors reviewed 770 patients with PACG, with a mean follow-up time of 109 months. Overall, 44 (5.7%) patients had optic disc hemorrhage (30 unilaterally) noted at some time point. A total of 111 disc hemorrhages were noted during the entire follow-up period, and 85 (77%) of these were located inferotemporally along the optic disc. There were 23 eyes with recurrent hemorrhages; of these, 11 (48%) involved the same area of the optic disc. The optic disc hemorrhages lasted just under 13 weeks and the IOP and cup-to-disc ratio did not differ between eyes with and fellow eyes without hemorrhages. Progressive changes in cup-to-disc ratio and visual field loss were noted in eyes with optic disc hemorrhage.

The 9-year follow-up in this study was a longer follow-up period than in other studies, suggesting particular accuracy in the noted frequency of optic disc hemorrhage in patients with PACG (5.7%). Although this figure reassures us that the presence of an optic disc hemorrhage in patients with PACG is uncommon, its appearance must be noted as it has important implications on the progression of disease and visual field loss. It suggests a worsening in the appearance of the optic disc and visual field, indicating progression of the optic neuropathy. There was a higher prevalence of involvement of the temporal aspect of the optic disc, especially the inferotemporal sector, a finding consistent with prior studies on glaucomatous optic disc hemorrhages.[2] The authors reviewed potential causes of optic disc hemorrhage in glaucoma, including a sign of underlying vascular pathology and a direct consequence of mechanical changes of the optic nerve head induced by elevated IOP.

Abstract

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