Clinical Characteristics and Prognostic Significance of Disc Hemorrhage in Open-angle and Angle-closure Glaucoma

Purpose: To analyze the clinical characteristics and prognostic significance of disc hemorrhage in primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), and primary angle-closure glaucoma (PACG).

Methods: Records of patients with POAG, NTG, or PACG and a history of disc hemorrhage were collected for this retrospective, observational cohort study.

Results: Of 1134 patients with POAG, 513 with NTG and 770 with PACG, 63 (5.6%), 36 (7.0%), and 44 (5.7%), respectively, had disc hemorrhage over a mean of 9 years of follow-up. There were no significant differences in the laterality, episodes, duration of hemorrhage, and frequency of recurrent hemorrhage among the 3 types. The intraocular pressure and cup-to-disc ratio did not differ significantly between eyes with and fellow eyes without hemorrhage. There was a significant association between disc hemorrhage and visual field progression [odds ratio: 2.78 (P = 0.004), 3.75 (P = 0.040), and 4.50 (P = 0.011) for POAG, NTG, and PACG, respectively].

Conclusions: Normal tension glaucoma has the highest incidence of disc hemorrhage, followed by PACG and POAG, which have similar incidence. The clinical characteristics of hemorrhage are not different among 3 types of glaucoma. The presence of disc hemorrhage is associated with the progression of glaucomatous optic neuropathy and visual field defects in POAG, NTG, and PACG.