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Tadamichi Akagi, Linda M Zangwill, Luke J Saunders, Adeleh Yarmohammadi, Patricia Isabel C Manalastas, Min Hee Suh, Felipe Medeiros, Christopher A Girkin, Jeffrey M Liebmann, Robert N Weinreb; Rates of Local Retinal Nerve Fiber Layer (RNFL) Thinning before and after Disc Hemorrhage (DH) in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1588. doi: https://doi.org/.
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The relationship between structural damage and DHs is not well understood. We investigated longitudinal temporal and spatial associations between rates of RNFL thinning before and after DHs and the influence of glaucoma treatment on the results.
Eyes with at least 1 superior or inferior DH episode and with spectral-domain optical coherence tomography (OCT; Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) follow-up both before and after DH were included from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. All subjects underwent optic disc photography every 12 months and spectral-domain OCT imaging every 6 months. The location of the DH or RNFL thickness was classified into 4 90-degree sectors. The rates of RNFL thinning was compared before and after DH and also between DH-located and non DH-located quadrants using multivariate linear mixed-effects models. Treatment intensification was defined as the glaucoma surgery or increase in the number of glaucoma medications.
36 eyes of 33 glaucoma patients and glaucoma suspects were included. The rates of RNFL thinning (mean±SD) were significantly faster at DH-located quadrants than non DH-quadrants after DH (-2.25±1.49 versus -0.69±1.14 μm/yr, P <.001), but not significantly different between DH-located and non DH-located quadrants before DH (-2.01±1.49 versus -1.91±1.69 μm/yr, P =.71). In 18 eyes with treatment intensification after DH, the rate of RNFL thinning at non DH quadrant became significantly slower after DH (P <.001), while the rate in the DH quadrant did not change (P =.19). In contrast, in 18 eyes with unchanged treatment after DH, the rate of RNFL thinning in DH quadrant was much faster after DH than before DH (P =.008), while the rate in the non-DH quadrant did not change (P =.69). Overall, the intensification of glaucoma treatment after DH significantly reduced the global and local rates of RNFL thinning after DH compared to before DH (global, P =.004; DH-located, P =.005; non DH-located, P <.001).
There is a worsening of the rate of RNFL thinning in a DH-located quadrant after DH. Moreover, glaucoma treatment intensification has a beneficial effect to reduce the rate of RNFL thinning after DH.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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