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T. S. Prata, C. G. V. De Moraes, C. C. Teng, C. Tello, R. Ritch, J. M. Liebmann; Which Glaucoma Patients With Disc Hemorrhage Progress Faster?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5834.
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Since glaucoma is a multifactorial disease, the effect of intraocular pressure (IOP) on glaucoma progression likely varies based upon the presence of other risk factors. We sought to investigate factors associated with a faster rate of visual field (VF) progression after optic disc hemorrhage (DH), an important risk factor for glaucoma progression.
Disc photographs of all patients with ≥5 SITA-Standard 24-2 VFs from 1999 to 2008 were reviewed for the presence of DH. Exclusion criteria were cataract extraction during the evaluated period, conditions other than glaucoma likely to affect the VF and insufficient number of VFs to create a slope after DH detection. Pointwise linear regression (Progressor®) was used to determine the rate of VF loss after DH detection. Assessed variables included baseline (age, IOP, CCT, VF MD, presence of exfoliation syndrome) and post-DH data (DH recurrence, antiglaucoma surgery, IOP reduction). Eyes were also stratified based upon IOP prior to DH (median split).
We enrolled 79 eyes (mean baseline IOP, 16.6 ± 3.9 mmHg). Mean age and MD were 68.9±10.8 yrs and -4.9±5.2 dB, respectively. The overall progression rate after DH was -0.98±1.22 dB/yr (mean follow-up, 3.7±2.9 years). For all eyes, multivariate analysis revealed a worse MD to be the only factor associated with a faster rate of progression (r=0.33, p=0.02) in these DH eyes. In the group that developed DH with low IOP (mean IOP 13.6±1.9 mmHg), a thinner CCT (r=0.24, p=0.04) and a higher IOP (r=0.24, p=0.02) were also associated with more rapid progression. In the group that developed DH with high IOP (19.7±3.1), the only significant factor was a worse MD (r=0.45, p=0.02).
A worse MD (more advanced glaucoma) is associated with a faster rate of VF loss in DH eyes, regardless of IOP. In eyes with IOP <16 mmHg, the additional risks associated with a thinner CCT and higher IOP suggest a role for IOP-dependent disease in these eyes.
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