The Relationship Between Recurrent Optic Disc Hemorrhage and Glaucoma Progression

Objective: To compare the clinical characteristics and progression rates of glaucoma in patients with recurrent and single disc hemorrhages (DHs).

Design: Retrospective comparative case series.

Participants: Patients with DH.

Methods: The medical records of 57 eyes of 54 patients with DH were reviewed retrospectively. These patients had been regularly followed up at 1- to 3-month intervals, between 1991 and 2003, for at least 1 year after the initial DH. The recurrent DH group was composed of patients who had experienced > or =2 episodes of hemorrhage, whereas the single DH group was composed of those who had experienced a single DH episode. These 2 patient groups were compared with respect to clinical courses after initial DH and their clinical characteristics.

Main Outcome Measures: Progression of optic disc and visual field (VF) deterioration.

Results: Twenty-six of the eyes in this study (45.6%) exhibited recurrent DH, and 31 eyes (54.4%) single DH. The average total follow-up period in the recurrent DH group was 67.5 months, whereas single DH patients were followed up for an average of 54.7 months. There were no differences between the groups with regard to age, diagnosis, follow-up period, associated disease, or mean deviation in automated perimetry. Normal-tension glaucoma was the most commonly encountered glaucoma type, and the inferotemporal area was the most common location of DH in both groups. The cumulative probability of optic disc deterioration, including retinal nerve fiber layer change after DH, was found to be significantly greater in patients with recurrent DH (P = 0.004, log rank test). However, no significant differences were found between the 2 groups with regard to rate of VF deterioration (P = 0.10, log rank test).

Conclusions: No differences were found between the recurrent and single DH groups in terms of clinical characteristics. Recurrent DH in cases of glaucoma may reflect more rapid optic nerve head damage progression than single DH.