Optic disk characteristics before the occurrence of disk hemorrhage in glaucoma patients

Abstract

PURPOSE: To evaluate qualitatively the structural characteristics and the associated features that antedate the occurrence of a disk hemorrhage in patients with glaucoma. METHODS: Retrospective observational case series. A total of 4018 pairs of stereoscopic optic disk images obtained over 15 years were reviewed. All eyes with optic disk images before the occurrence of a disk hemorrhage were enrolled. The disk images were evaluated in a masked fashion with respect to the general neural rim and peripapillary appearance. RESULTS: The optic disk characteristics and associated features that most antedate the disk hemorrhage in 33 eyes of 26 patients that had previous optic disk images for evaluation are focal neural rim notch (36%), thin sloping rim (42%), peripapillary atrophy (79%), and superior-inferior rim asymmetry (73%). In eyes with preexisting focal rim notches, all subsequent disk hemorrhages were identified at or adjacent to the notches. CONCLUSIONS: Focal rim notching may precede the occurrence of a disk hemorrhage.