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Ahnul Ha, Young Kook Kim, Sung Uk Baek, Ki Ho Park, Jin Wook Jeoung; Optic Disc Microhemorrhage in Primary Open-Angle Glaucoma: Clinical Implications for Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2019;60(6):1824-1832. doi: https://doi.org/10.1167/iovs.19-26673.
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To establish the existence of minute-sized optic disc hemorrhage (DH; i.e., optic disc microhemorrhage [micro-DH]) in primary open-angle glaucoma (POAG) and to evaluate its clinical implications for glaucoma progression.
Retrospective analysis of prospectively collected data.
POAG patients with macro-DH who had met the following conditions were included: follow-up period 7 years or longer (at least 3 years before and at least 4 years after the date of first macro-DH), and more than nine reliable VF results. Micro-DH was defined as a less than 0.01-mm2 area DH that is undetectable on conventional stereo disc photography (SDP) but can be discriminated by enhanced SDP. SDPs were enhanced by customized image-compensation software. Each enhanced image was evaluated to determine the presence of micro-DH. VF progression was confirmed by standard automated perimetry's guided progression analysis.
Among the 107 POAG eyes with macro-DH, micro-DH was detected prior to macro-DH in 39 (36.4%), the median time lag being 13.6 months. Over the course of the mean 7.1 ± 0.8-year follow-up period, 40 of 107 eyes showed VF progression: 21 (53.8%) of the 39 eyes of the micro-DH positive group and 19 (27.9%) of the 68 eyes of the micro-DH–negative group (P = 0.008). In the micro-DH–positive group, the cumulative VF-progression probability was significantly greater (P = 0.001), and the overall VF-deterioration rate was much faster (−1.01 ± 0.58 vs. −0.78 ± 0.49 dB/year, P = 0.029).
Micro-DH was found prior to macro-DH detection in a significant proportion of POAG patients; micro-DH, moreover, was associated with earlier and faster VF progression.
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