Evaluation of the relationship between glaucomatous disc subtypes and occurrence of disc hemorrhage and glaucoma progression in open angle glaucoma

Akiko Yamagami,Makoto Araie,Astuo Tomidokoro,Shun Matsumoto,Yoshio Yamazaki,Goji Tomita,Junkichi Yamagami,Keiji Yoshikawa

doi:10.1038/s41598-020-77932-z

Abstract

To compare the occurrence of disc hemorrhages (DH) and glaucoma progression in open-angle glaucoma (OAG) patients with different glaucomatous disc types. Prospective, hospital-based, observational cohort study. OAG patients examined between 2000 and 2005, whose discs were classified as typical myopic glaucomatous (MG), generalized enlargement of cup (GE), or focal glaucomatous (FG) disc type were included and followed for 5 years. The first occurrence of DH during follow-up was analyzed using Kaplan–Meier analysis and difference in DH occurrence based on glaucomatous disc type using the Cox proportional-hazards model to adjust for effects of confounding factors. For inter-group comparison of glaucoma progression, the change rate of the mean deviation, Collaborative Initial Glaucoma Treatment Study scores, and fundus photographs were used. Thirty-nine patients with MG-, 18 with FG-, and 17 with GE-disc types were included. No significant inter-group difference was seen in the rate of glaucoma progression. The five-year probability of DH occurrence was much lower with MG- than with FG- or GE-disc types (P < 0.0220). The central corneal thickness (P = 0.0024) and mean intraocular pressure and its variations (P = 0.0450, 0.0219) contributed to DH occurrence. The MG-disc type demonstrated a much lower DH occurrence during follow-up than other disc types.

Highlights

To compare the occurrence of disc hemorrhages (DH) and glaucoma progression in open-angle glaucoma (OAG) patients with different glaucomatous disc types
In the analysis performed by converting standard deviation (SD) to CV, we found that glaucomatous disc subtype (P = 0.0087), central corneal thickness (CCT) (P = 0.0020), and CV of intraocular pressure (IOP) recorded during follow-up (P = 0.0173) significantly contributed to the 1st DH during follow up
Differences in clinical associations and prognoses associated with the appearances of glaucomatous optic discs have been reported; the focal glaucomatous (FG) disc type is more likely to be associated with the female sex, local visual field (VF) defects, migraine and vasospasm, and a faster rate of p rogression[13,15,17]; the generalized enlargement of cup (GE) disc type is more likely to be associated with higher untreated IOP and diffuse VF d efects[13,15]; and the senile sclerotic (SS) disc type is associated with older age, systemic cardiovascular diseases, compromised retrobulbar circulation, thinner peripapillary choroid, and a slower rate of progression[13,14,15,16]

Summary

Introduction

To compare the occurrence of disc hemorrhages (DH) and glaucoma progression in open-angle glaucoma (OAG) patients with different glaucomatous disc types. OAG patients examined between 2000 and 2005, whose discs were classified as typical myopic glaucomatous (MG), generalized enlargement of cup (GE), or focal glaucomatous (FG) disc type were included and followed for 5 years. Disc hemorrhage (DH) is a well-known risk factor for progression of visual field (VF) defects in open-angle glaucoma (OAG)[1,2,3,4], but the mechanism of development of DHs has not been clarified. We report the results of a 5-year prospective comparative observational cohort study of the occurrence of DH and the rate of glaucoma progression in eyes with OAG with different types of glaucomatous optic discs

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Conclusion