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Ximena Andrea Arata, Gustavo V. De Moraes, Christopher C. Teng, Celso Tello, Jeffrey M. Liebmann, Robert Ritch; Clinical Characteristics and Rates of Visual Field Progression in Normal-Tension and Exfoliative High-Tension Glaucoma Patients with Optic Disc Hemorrhages. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4139.
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To investigate clinical characteristics and differences between normal-tension (NTG) and high-tension exfoliative glaucoma (XFG) patients with detected optic disc hemorrhages (DH). We limited our high tension group to XFG to minimize overlap with the NTG eyes and emphasize the IOP-dependent disease process.
All periodic optic disc photographs of patients seen in a glaucoma referral practice from 1/09 to 3/10 were reviewed by two glaucoma specialists searching for DH. Optic disc and clinical characteristics were recorded and compared between eyes with NTG and XFG patients. We evaluated the rates of VF change among eyes with ≥ 5 24-2 SITA VF tests after the first detected DH using automated trend-analysis.
Out of 305 eyes (278 patients; mean age, 68±13 yrs; 61% women; 98% European ancestry) with at least one detected DH, 49 eyes had NTG and 59 eyes had XFG. NTG subjects were younger (66±11 vs 75±9 yrs, p<0.01) and had lower mean IOP measurements on the date of the DH (14±2 vs 18±5 mmHg) than XFG eyes. The proportion of eyes experiencing recurrent DH was similar between the two groups (16 vs 17%, p= 0.86). The VF closest to the date of the DH revealed similar MD (-7±6 vs -7±7 dB, p=0.98) and PD values (7±4 vs 6±4 dB, p= 0.28) between groups. The most frequent locations for DH in the NTG group were IT (55%), T (20%), and ST (12%) and in XFG they were IT (40%), T (30%), and ST (15%) (p= 0.35). There were no differences in the prevalence of systemic hypertension (36 vs 54%, p= 0.09), diabetes (6 vs 8%, p= 0.97), Raynaud’s/migraine (21 vs 8%, p= 0.09), hyperlipidemia (36 vs 30%, p= 0.91), and use of aspirin or anticoagulants (23 vs 24%, p=0.91) between the NTG and XFG groups, respectively. The global rate of VF change were also similar (-0.7±0.7 and -0.6±0.6 dB/yr, p=0.80).
NTG and XFG patients with detected DH showed different age and IOP at the date of the first documented hemorrhage. Even though NTG and XFG eyes have been reported to differ with respect to IOP-dependent and IOP-independent mechanisms and different velocities of VF progression, the rates of VF change in eyes with DH are similar. This emphasizes the role of DH as an independent feature associated with glaucoma progression.
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