Re-bleeding of glaucomatous disc haemorrhages. Six-month analysis of the Prospective Observational Study of disc Haemorrhages: POSH.

Abstract

Purpose : To identify the frequency of, and risk factors for, re-bleeding in a cohort of glaucoma patients with a baseline disc haemorrhage (DH) over a period of 6 months.

Methods : Thirty patients with open angle glaucoma and DH were recruited at Moorfields Eye Hospital as part of POSH and followed for five visits over one year of follow-up. The current report includes data from baseline, 1, 3, and 6 months follow-up. Among other examinations, patients underwent nailfold capillaroscopy and answered questionnaires about primary vascular dysregulation (PVD) symptoms describing the ‘Flammer syndrome’ (migraine headaches, aura phenomena, cold hands and feet, ringing in the ear or sudden hearing loss, reduced thirst and insomnia). We explored possible risk factors for re-bleeding among the PVD symptoms and nailfold capillaroscopy findings (capillary density and the presence of nailfold haemorrhages). Univariable and multivariable logistic regression analyses were performed with re-bleeding as the dependent variable and PVD symptoms or nailfold capillaroscopy findings as possible predictors, adjusting for age and gender.

Results : Thirteen (43%) patients re-bled in the same or contralateral optic nerve. Among the studied variables, only insomnia was significantly associated with a reduced risk for re-bleeds in both the univariable (odds ratio = 0.025 [95% CI 0.001-0.674], P=0.028; Table 1) and multivariable (odds ratio = 0.057 [95% CI 0.005-0.705], P=0.026; Table 2) logistic regressions. None of the other predictive variables showed significant results.

Conclusions : Almost half the participants with a baseline DH had a rebleed in the first six months of follow-up. Capillaroscopic findings and most of the so-called Flammer symptoms were unable to predict rebleeding episodes. Only one, insomnia, showed a possible effect in both univariable and multivariable analyses and this was in the direction of being protective.

This is a 2020 ARVO Annual Meeting abstract.