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Impressum
Morphologic risk factors for development of Optic Disc Hemorrhages in Chronic Open-Angle Glaucoma
1Degenring R., 2Budde W. M., 2Hayler J., 3Martus P., 1Jonas J. B.
1Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany; 2Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany; 3Institute for Medical Informatics, Biometry, and Epidemiology, FU Berlin, Klinikum Benjamin Franklin, Berlin, Germany
Purpose: To evaluate which morphologic features of the optic disc
are risk factors for the development of optic disc hemorrhages in the
follow-up examination of patients with chronic open-angle glaucoma.
Patients and Methods: The prospective comparative clinical observational
study included 336 eyes of 169 Caucasian patients with chronic open-angle
glaucoma. Mean follow-up time was 28.3 ± 17.5 months. The whole
study group was differentiated into eyes with an optic disc hemorrhage
during the follow-up period (n=36; 36/336=10.7%), eyes with loss of neuroretinal
rim, enlargement of parapapillary atrophy or decreasing visibility of
the retinal nerve fiber layer as signs of progression of glaucoma (n=115;
115/336=34.2%), and eyes without morphologic changes of the optic nerve
head during the follow-up period (n=185; 185/336=55.1%). All patients
underwent repeated qualitative and morphometric evaluation of color stereo
optic disc photographs. Main outcome measures were frequency of optic
disc hemorrhages, and qualitative and quantitative morphologic optic nerve
head parameters.
Results: At baseline of the study, the group of eyes with disc
bleedings and the group of eyes without progression did not vary significantly
(P>0.10) in size and shape of the optic disc, depth of the optic cup,
alpha zone of parapapillary atrophy, and diameter of the retinal arteries
and veins at the optic disc border. In the group with disc hemorrhages
compared with the non-progressive group, neuroretinal rim area as a whole
(P<0.001) and in the four disc sectors (P=0.005) was significantly
smaller, and beta zone of parapapillary atrophy was significantly (P=0.02)
larger. Comparing eyes with disc bleedings and eyes with progression as
defined by neuroretinal rim loss, enlarging parapapillary atrophy and
decreasing nerve fiber layer visibility, revealed no statistically significant
differences in any optic disc parameter measured.
Conclusions: Most important morphologic risk factors for the development
of glaucomatous optic disc hemorrhages are small size of neuroretinal
rim, and large area of beta zone of parapapillary atrophy. Development
of optic disc hemorrhages in glaucomatous eyes is independent of size
and shape of the optic disc, size of alpha zone of parapapillary atrophy,
retinal vessel diameter, and optic cup depth.