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Christopher C. Teng, Carlos G. De Moraes, Jeffrey M. Liebmann, David S. Greenfield, Stuart K. Gardiner, Robert Ritch, Theodore Krupin, LoGTS Investigators; Risk Factors for Optic Disc Hemorrhage in the Low-pressure Glaucoma Treatment Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):261.
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To investigate risk factors associated with optic disc hemorrhage (DH) in the Low-pressure Glaucoma Treatment Study (LoGTS), a prospective trial designed to compare the effects of the alpha2-adrenergic agonist brimonidine tartrate 0.2% to the beta-adrenergic antagonist timolol maleate 0.5% on visual function in low-pressure glaucoma.
LoGTS participants with ≥ 5 visual fields during the follow-up were included. Optic disc photographs were reviewed for the presence of DH by two glaucoma specialists and cases of disagreement were adjudicated after consensus. Ocular and systemic risk factors were analyzed using generalized estimated equations (GEE) with a three-level ordinal response (0 for no DH, 1 for 1 DH, and 2 for recurrent DHs). Ocular and systemic risk factors (eg: age, gender, blood pressure, and ocular perfusion pressure) were investigated. Follow-up time and number of disc photographs were entered in the regression models given their confounding effect. Variables with p<0.25 in the univariate analysis were included in an initial multivariate model, and single backwards elimination was then used to derive the final model (alpha-level=0.05).
253 eyes of 127 subjects (mean age, 64.7±10.9 years; mean follow-up, 40.6±12 months) were analyzed. 9/69 (13%) patients in the timolol group had at least one DH versus 5/58 (8%) in the brimonidine group (P =0.57). In the univariate analysis, the only significant factor for DH was positive history of migraine (OR =4.52, P =0.03). Randomization to timolol had an OR =1.77 (P =0.33). In the multivariate analysis, independent risk factors were female sex (OR =3.48, P =0.01), positive history of migraine (OR =2.81, P <0.01), and lower mean systolic pressure during follow-up (OR =1.03, P =0.05).
Despite a trend of more DHs detected in the timolol group, randomization to brimonidine rather than timolol did not affect the risk of DH in LoGTS. The fact that other variables remained significant predictors underscores the role of IOP-independent factors in the pathogenesis of DHs in patients with low-pressure glaucoma.
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