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Follow-Up Examination of Eyes with Chronic Open-Angle Glaucoma and Optic Disc Hemorrhages
1Harder B., 2Martus P., 1Budde W. M., 1Jonas J. B.,
1Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)
2Freie Universität Berlin, Klinikum Benjamin Franklin, Institut für Medizinische Informatik, Biometrie und Epidemiologie (Berlin)
Purpose: To evaluate the frequency of eventual neuroretinal rim loss in glaucomatous eyes with optic disc hemorrhages.
Methods: The prospective comparative clinical observational study included 78 eyes of Caucasian patients with chronic open-angle glaucoma and a flame-shaped optic disc hemorrhage at the time of presentation. All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Mean follow-up time was 3.07 ± 1.96 years (range, 0.98 - 10,01 years).
Results: Thirty-six (46.2%) of the 78 eyes with disc hemorrhages showed loss of neuroretinal rim during the follow-up period. For the remaining 42 eyes (53.8%), no changes of the neuroretinal rim could be detected on the optic disc photographs. The group with eventual progression did no vary significantly from the group with an unchanged neuroretinal rim in area of the optic disc (2.81 ± 0.50 mm2 versus 3.12 ± 0.78 mm2; p=0.10), size of alpha zone of parapapillary atrophy (0.82 ± 0.61 mm2 versus 0.99 ± 0.63 mm2; p=0.47), beta zone of parapapillary atrophy (0.47 ± 0.49 mm2 versus 0.49 ± 0.59 mm2; p=0.84), and duration of the follow-up period (2.51 ± 1.31 years versus 3.54 ± 2.29 years; p=0.05). The neuroretinal rim was significantly smaller in the progressive group (0.86 ± 0.26 mm2 versus 1.02 ± 0.35 mm2; p=0.02).
Conclusions: With a probability of at least 45-50%, occurrence of optic disc hemorrhages in eyes with chronic open-angle glaucoma is correlated with progression of glaucomatous optic nerve damage as shown by eventual loss of neuroretinal rim in a follow-up period of about three years. The risk to show loss of rim after an optic disc hemorrhage was statistically independent of optic disc size, and area of beta zone or alpha zone of parapapillary atrophy. Eyes with small rim had a higher risk to lose rim than eyes with a relatively large rim.