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Study: Disc hemorrhages linked to progression of optic neuropathy, visual field defects in PACG patients

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Despite the relative infrequency of disc hemorrhage among patients with primary angle-closure glaucoma, there appears to be an association between these hemorrhages and both the progression of glaucomatous optic neuropathy and visual field defects, a retrospective study suggests.

To evaluate the characteristics of disc hemorrhages, Yu-Wen Lan, MD, MSc, and colleagues reviewed records for 770 patients with primary angle-closure glaucoma (PACG). Specifically, the investigators assessed the location, number of episodes and duration

of disc hemorrhages, as well as IOP, cup-to-disc ratio and visual fields. Follow-up averaged 109.2 months, ranging from 7 months to 261 months.

Of the 770 patients, 44 (5.7%) had a history of disc hemorrhage; of these, 30 (68%) had unilateral hemorrhages and 14 (32%) had bilateral hemorrhages, the authors noted.

"This is considerably higher than previously reported, particularly because we may well have underestimated the true incidence," they said in the August issue of Ophthalmology.

Overall, there were 111 hemorrhages in 58 eyes, of which 85 (77%) occurred in the inferotemporal sector of the optic disc and 19 (17%) occurred in the superotemporal sector of the disc.

Of 23 eyes that had recurrent disc hemorrhages, 11 (48%) had hemorrhages that recurred in the same sector of the disc; the average duration of these hemorrhages was 12.8 weeks.

The investigators reported no significant differences in IOP and cup-to-disc ratios between eyes with hemorrhages and fellow eyes without hemorrhages.

While patients with unilateral disc hemorrhages showed progressive changes in the cup-to-disc ratio in both hemorrhagic and non-hemorrhagic eyes, visual field defects worsened only in eyes with hemorrhages.

"We urge careful fundus examination for disc hemorrhage in [PACG] patients as well as further investigations designed to overcome the obstacles to identifying disc hemorrhages" the authors said.