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Flávio Siqueira Santos Lopes, Daniela L Junqueira, Luis G Biteli, Syril Dorairaj, Tiago S Prata; CLINICAL PROFILES OF GLAUCOMATOUS PATIENTS WITH HIGH- AND LOW-TENSION OPTIC DISC HEMORRHAGES. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4300.
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We sought to characterize distinct clinical subtypes of glaucomatous patients with high (HTDH) and low-tension optic disc hemorrhages (LTDH).
In this prospective study, we enrolled consecutive glaucomatous patients, examined between January-November 2013. Glaucoma was defined as glaucomatous optic neuropathy and reproducible visual field defects (all patients with previous experience in VF testing [≥ 3 exams]). Disc photographs of all patients were evaluated for the presence of DH by two glaucoma specialists. Eyes with diabetic retinopathy, vascular occlusive disease, recent history of posterior vitreous detachment, and any ocular disease other than glaucoma were excluded. Patients were classified as HTDH if presenting with an intraocular pressure (IOP)≥16 mmHg at the time of DH detection. Those with an IOP<16 mmHg were classified as LTDH. Clinical and ocular data from the time of DH detection were collected and compared between patients with HTDH and LTDH. Whenever both eyes were eligible, one was randomly selected for analysis.
A total of 40 patients were included (HTDH=15 eyes; LTDH=25 eyes). Patients with LTDH were more often women than those with HTDH (84% vs 40%; p<0.01). Eyes with LTDH had lower visual field index values (80% vs 93%) and a higher frequency of paracentral field involvement (83% vs 40%) than those with HTDH (p≤0.04). Although the LTDH patient group had thicker corneas (mean difference of 19.8μm) and a higher prevalence of Asian descendants (32% vs 7%) compared to the HTDH patient group, this difference did not reach statistical significance (p=0.11). The most common optic disc phenotypes in eyes with LTDH and HTDH were the focal (39%) and the generalized cup enlargement (43%), respectively. No significant differences were found regarding age, number of medications, DHs location, and recurrences (p≥0.16).
There are significant differences between patients with HTDH and LTDH. Patients developing DHs with treated IOPs in the low teens (<16 mmHg) are most frequently women with focal rim loss, and present with more advanced and central visual field defects than those with higher IOPs. Race and corneal thickness also seem to differ between these two clinical subtypes. We believe these findings add to the clinical management of these patients, and that special care should be taken regarding optic disc evaluation to those with the LTDH subtype.
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