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A.S. Soares, M.T. Nicolela, P.H. Artes, R.P. LeBlanc, B.C. Chauhan; Factors Associated with Optic Disc Hemorrhages in a Longitudinal Study of Patients with Open-angle Glaucoma . Invest. Ophthalmol. Vis. Sci. 2003;44(13):99.
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Purpose: To study the relationship between optic disc hemorrhages (ODH) and intraocular pressure (IOP), systemic disease and use of anticoagulant medication in a longitudinal study of patients with open-angle glaucoma. Methods: The presence of ODH, systemic diseases, IOP and use of anticoagulant medication were recorded from each visit in patients identified from prospective studies in our institution. Logistic regression analysis was performed to determine whether any systemic disease or use of anticoagulants were predictive of ODH. To investigate the relationship between IOP and ODH, we calculated the difference between the IOP at the time the first ODH was detected and the mean IOP of the previous 3 visits. In cases of bilateral ODH, one randomly selected eye was chosen. The same analysis was additionally performed for patients with multiple episodes of ODH where one random episode was selected. As a control, the same analysis was performed for one randomly selected visit and eye in patients with no ODH in either eye during the follow-up. Results: Our sample included 137 patients whose mean ± SD follow-up and visits/year were 9.6 ± 5.0 and 3.0 ± 1.0 respectively. ODH were observed in 38 (28%) patients of whom 12 (32%) had bilateral ODH. Twenty eyes (40%) had multiple episodes of ODH (range 2-8), totalling 98 episodes. ODH were significantly associated with aspirin use (odds ratio = 3.7, 95% CI = 1.5 to 9.5, P = 0.006). There was no significant association between ODH and gender, age, refractive error or presence of diabetes, hypothyroidism, migraine, heart disease, high cholesterol and systemic hypertension. At the first ODH episode, the mean ± SD IOP was 1.5 ± 2.5 mmHg lower compared to the mean of the 3 previous visits (P = 0.002). The respective figure for the randomly selected ODH episode was 1.1 ± 2.5 (P = 0.014). In patients with no ODH, no significant difference was observed (0.35 ± 3.5 mmHg, P = 0.33). Conclusions: Use of aspirin was significantly associated with ODH indicating either that patients taking aspirin have a higher frequency of ODH or larger ODH which take longer to re-absorb increasing the likelihood of detection. ODH tend to occur at relatively lower levels of IOP during a patient's follow-up.
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