Characteristics of Disc Hemorrhage in Primary Angle-closure Glaucoma

Abstract

To analyze the characteristics of disc hemorrhage in primary angle-closure glaucoma (PACG). Retrospective noncomparative case series. Patients seen in glaucoma clinics with PACG and a history of disc hemorrhage. Goldmann tonometry, gonioscopy, ophthalmoscopy, and automated perimetry. Location, number of episodes, and duration of disc hemorrhage; comparison of intraocular pressure (IOP) and cup-to-disc ratio (CDR) in eyes with and fellow eyes without hemorrhage; and changes of CDR and visual fields (VFs) on follow-up. The mean duration of follow-up was 109.2+/-63 months (range, 7-261). Of 770 patients with PACG, 44 (5.7%) had disc hemorrhage at some point in their history, of whom 30 (68%) had unilateral and 14 (32%) had bilateral hemorrhages, either alternately or simultaneously in both eyes. There were a total of 111 hemorrhages in 58 eyes, including 23 eyes (40%) with recurrent hemorrhages. Of the 111 total hemorrhages, 85 (77%) occurred in the inferotemporal and 19 (17%) in the superotemporal sector of the disc. Among 23 eyes with recurrent disc hemorrhages, 11 (48%) had recurrence in the same sector of the disc. The average duration of hemorrhages was 12.8+/-8.1 weeks. The IOP and CDR did not differ significantly between eyes with and fellow eyes without hemorrhage. For patients with unilateral disc hemorrhage, progressive changes in the CDR were found in both the eyes with and fellow eyes without disc hemorrhage, but VF defects worsened only in eyes with disc hemorrhage. The incidence of disc hemorrhage in patients with PACG was 5.7% over 9 years of follow-up. Despite its relative infrequency, disc hemorrhage in PACG was associated with progression of glaucomatous optic neuropathy and VF defects.