Optic Disc Hemorrhage Research Articles

A rare case of infiltrative optic neuropathy caused by vitreoretinal lymphoma with hyperreflective deposits in the intraretinal and subretinal pigment epithelial layers prior to the disease onset

BackgroundTo describe a rare case of infiltrative optic neuropathy (ION) caused by vitreoretinal lymphoma (VRL) with hyperreflective deposits in the intraretinal and subretinal pigment epithelial (RPE) layers before the disease onset.Case presentationAn 87-year-old Japanese female, previously treated for unexplained uveitis in the right eye, was referred for further evaluation. Despite the absence of intraocular inflammation or vitreous opacification (VO), yellowish-white deposits were noted in the macula, and OCT revealed hyperreflective deposits in the intraretinal and sub-RPE layers. One month later, she returned with acute visual deterioration. Optic disc swelling and disc hemorrhage were observed without VO or intraocular inflammation. Magnetic resonance imaging (MRI) showed no abnormalities. One week later, VO developed and we performed a 25-gauge vitrectomy. Cytology, flow cytometry, and gene rearrangement confirmed malignant B-cell lymphoma. The diagnosis of ION secondary to VRL was made, and intravitreal methotrexate injections were administered a total of 6 times. Six months postoperatively, VO and optic disc swelling resolved, and visual acuity improved to 20/50, with no recurrence on MRI.ConclusionsAlthough there were reports on VRL advanced from hyperreflective deposits in the intraretinal or sub-RPE layers, there have been no studies that these OCT findings has progressed to ION with VRL. When differentiating optic neuropathy, OCT may assist in the diagnosis by evaluating intraretinal and sub-RPE findings.

Diabetic Papillopathy and Papillophlebitis

Diabetic papillopathy is a rare ocular finding in patients with diabetes mellitus. Optic disc edema accompanying minimal visual changes caused by diabetic papillopathy distinguishes it from other optic neuropathies. The pathophysiology of diabetic papillopathy is still not clearly understood. Patients with diabetic papillopathy tend to be asymptomatic, but they may present to the clinic with mild blurred vision. Diagnosis can be made by excluding other possible causes of optic disc swelling. Diabetic papillopathy is essentially a diagnosis of exclusion. For this reason, the differential diagnoses in these patients need to be well known. There are no proven treatment options for diabetic papillopathy. However, since these patients often recover on their own, following the patients without treatment seems to be a reasonable approach for now. Papillophlebitis is a rare condition look like as incomplete central retinal vein occlusion due to optic disc edema and hemorrhages at the disc edge. It typically occurs in young, healthy women with acute, painless unilateral vision loss or blurred vision, optic disc edema, and retinal vein engorgement. Diagnosis is made by excluding other possible causes. There is no evidence-based, accepted treatment method for papillophlebitis.

Case report of unilateral optic nerve infiltration in marginal zone B-cell lymphoma with retinal vein occlusion

This case report described a 61-year-old male patient who presented with unilateral optic nerve infiltration and retinal vein occlusion as ocular manifestations of marginal zone B-cell lymphoma (SMZL). The patient experienced sudden vision loss in his left eye, accompanied by a relative afferent pupillary defect and findings of optic disc edema, hemorrhage, and retinal ischemia upon fundus examination. The individual had a previous diagnosis of SMZL prior to the onset of ocular symptoms. Subsequent evaluations confirmed lymphoma infiltration of the left optic nerve and retinal vein occlusion. Following a month of chemotherapy, there was observed improvement in the left eye, characterized by the resolution of optic disc edema and retinal ischemia.

Prediction of glaucoma progression by 24-h contact lens sensor profile in patients with normal-tension glaucoma

A single-center prospective cohort study was conducted to investigate whether intraocular pressure (IOP)-related 24-h contact lens sensor (CLS) profile parameters can help predict glaucoma progression in patients with normal-tension glaucoma (NTG). CLS measurements (Triggerfish; SENSIMED, Etagnières, Switzerland) at baseline without medication were performed for 24 h in one eye, following diurnal IOP measurements using Goldmann applanation tonometry at 3-h intervals. Glaucoma progression during the follow-up period of ≥ 2 years was determined based on the Guided Progression Analysis of Humphrey visual fields and/or structural progression using fundus photographs. Among 79 patients (mean values: follow-up periods, 48.1 months; age, 51.5 years; baseline IOP, 14.0 mmHg; mean deviation, − 6.04 dB), 23 showed glaucoma progression. A smaller standard deviation of nocturnal ocular pulse amplitude in the CLS profile, a larger range of diurnal IOP at baseline, and the presence of optic disc hemorrhage (DH) during the study period were significant risk factors for glaucoma progression in the multivariate Cox proportional hazards model (hazard ratio, 0.30/mVeq, 1.23/mmHg, and 4.37/presence of DH; P = 0.016, 0.017, and 0.001, respectively). CLS measurements may be useful for assessing the risk of future glaucoma progression in patients with NTG, providing supplementary information to routine IOP measurements.

Standardizing the diagnosis and treatment of ocular hypertension based on evidence-based medicine

Ocular hypertension (OHT) refers to a condition in which the intraocular pressure increases without causing glaucomatous optic nerve changes or visual field damage. The incidence rate of OHT in people over 40 years old is as high as 4% to 10%. According to the OHT Treatment Study (OHTS), the incidence of primary open angle glaucoma (POAG) among OHT patients is increasing year by year, so it is necessary to conduct long-term follow-up. This article elaborates on five major risk factors for the progression of OHT to POAG: age, intraocular pressure, vertical cup-disc ratio, pattern standard deviation of visual field, and central corneal thickness. It also summarizes other potential risk factors, such as long-term fluctuations in intraocular pressure, asymmetry of intraocular pressure and visual field between the two eyes, structural phenotypes of the optic disk, and optic disk hemorrhage. Predicting the risk of OHT progression to POAG based on risk factors, patients with different risk levels require different timing for treatment initiation and follow-up intervals. Those with higher risks should start preventive treatment earlier and have shorter follow-up intervals. Both drug therapy and selective laser trabeculoplasty can serve as initial treatment options for OHT. Combining evidence-based medicine research and individualized evaluation of treatment can enhance the clinical diagnosis and treatment level of OHT.

Characteristics of optic disc hemorrhage and optic nerve changes following acute primary angle closure

IntroductionAcute primary angle closure (APAC) is an emergency ophthalmic presentation and a major cause of irreversible blindness in China. However, only a few studies have focused on the characteristics of optic disc hemorrhage (ODH) during an APAC attack, including its shape, depth, location, scope, and duration after intraocular pressure (IOP) control, along with changes in the optic nerve. This study aimed to analyze the characteristics of ODH and optic nerve changes in patients during their first APAC episode.MethodsThis retrospective study involved 32 eyes from 32 patients with APAC who received sequential treatment and analyzed the following parameters: the highest IOP and its duration, ODH, retinal nerve fiber layer thickness (RNFLT), and mean deviation (MD). We compared parameters obtained from the affected eye (ODH group) and contralateral unaffected eye (control group), as well as intragroup comparisons.ResultsThe mean IOP in the ODH group was 64.28 ± 10.36 mmHg, with a duration of 4.44 ± 2.35 days. Flame and splinter shapes accounted for 84.38% of the ODH. The mean ODH duration was 4.81 ± 3.25 weeks. ODH during APAC was isolated to one sector in 59.38% of cases, mostly occurring in the temporal superior and temporal inferior (each accounting for 21.88% of the cases). There was a positive correlation between the extent of hemorrhage and the highest IOP duration (p < 0.001). RNFLT was significantly thickened within 72 h post-IOP control but was thinned by 2 weeks. By 6 months, the thinning stabilized, and there was no difference noted between the ODH and control groups at 12 months. MD partly improved at 6 months post-IOP control, and ODH scope significantly affected the MD (p < 0.001). The duration of high IOP was positively correlated to the ODH scope and MD damage.DiscussionTimely and effective IOP management is essential for recovering visual function following an APAC attack.

Reduction of Optic Disc Microvasculature and Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma

PurposeTo assess the relationship between the change of optic disc vessel density (ODVD) and retinal nerve fiber layer (RNFL) thinning in primary open-angle glaucoma (POAG) patients. DesignRetrospective case series. MethodsFor 105 POAG patients, ≥ 5 consecutive optical coherence tomography (OCT) and OCT angiography (OCTA) images were obtained during ≥ 2 years of follow-up.Based on enface OCTA imaging, ODVD was calculated as the ratio of pixels occupied by vessels below the internal limiting membrane within the temporal area of the optic cup, and ODVD reduction was determined when there was a statistically significant negative slope (P < 0.05) for any of the global, superior, or inferior sectors. The association between the rates of ODVD change and RNFL thinning was assessed by multivariable longitudinal linear mixed-effects model vs. time. ResultsDuring 2.9 ± 0.3 years of follow-up on the 105 participants with visual field mean deviation at baseline of 5.7 ± 4.8 dB, 46 (43.8%) showed ODVD reduction. Faster global RNFL thinning was associated with the smaller Bruch's membrane opening area (ß = 0.381; 95% confidence interval (CI), 0.120 to 0.646; P = 0.006), optic disc hemorrhage (ß = -0.567; 95% CI, -0.909 to -0.228; P = 0.002) and faster rate of global ODVD change (ß = -0.090; 95% CI, -0.139 to -0.042; P = 0.001). ConclusionsReduction of optic disc microvasculature was associated with rapid RNFL thinning in POAG. This suggests a role for deep ONH circulation in the glaucoma pathogenesis.

Optic Disc Microvasculature Dropout in Preperimetric Glaucoma.

Optic disc microvasculature dropout (MvD-D) was associated with worse disease severity in pre-perimetric glaucoma. MvD-D was not accompanied by focal lamina cribrosa defect or parapapillary deep-layer microvasculature dropout in 62.3% and 71.0% of eyes, respectively. To investigate factors associated with optic disc microvasculature dropout (MvD-D) in patients with preperimetric primary open angle glaucoma (PPG). One hundred thirty nine eyes of PPG patients were categorized according to the presence of MvD-D with optical coherence tomography angiography (OCTA). Factors including visual field (VF) mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, focal lamina cribrosa (LC) defect, optic disc hemorrhage (DH), and parapapillary deep-layer microvasculature dropout (MvD-P) were compared between eyes with and without MvD-D. MvD-D was observed in 69 PPG eyes (49.6%). Compared with eyes without MvD-D, the ones with MvD-D had a significantly thinner RNFL in all areas except the nasal sector, worse VF MD, and a focal LC defect and MvD-P ( P <0.05): male gender also was more highly prevalent. A considerable number of eyes with MvD-D lacked focal LC defect (62.3% [43/69]) or MvD-P (71.0% [49/69]), while a few eyes without MvD-D had focal LC defect (10.0% [7/70]) or MvD-P (2.9% [2/70]). In a multivariable logistic regression analysis, male gender (odds ratio [OR], 3.96; P <0.001), worse VF MD (OR, 1.44; P =0.019), thinner global RNFL (OR, 1.13; P <0.001), higher prevalence of focal LC defect (OR, 3.71; P =0.014) and MvD-P (OR, 7.85; P <0.001) were significantly associated with MvD-D. MvD-D was related to worse disease severity in patients with PPG, and often was not accompanied by focal LC defect or MvD-P. This suggests that impaired optic disc circulation can be an early sign of glaucoma without noticeable changes in functional or structural features (i.e., VF, focal LC defect, MvD-P).

Vascular insufficiency leading to recurrent disc haemorrhage in normotensive glaucoma

Disc haemorrhage is a sign of progression in normotensive glaucoma. We report a case who was presented with right eye (RE) optic disc haemorrhage and retinal nerve fibre layer defect at first visit, he was diagnosed as normotensive glaucoma (NTG). On subsequent follow up visits he had recurrent disc haemorrage and progression in visual fields and optical coherence tomography (OCT). On further evaluation he had h/o of dehydration episodes as he lives in hotter climates and on systemic evaluation he had carotid stenosis and nocturnal dip in 24 hr blood pressure monitoring. This case tells about importance of systemic evaluation in normotensive glaucoma.

Clinical Significance of Optic Disc Hemorrhage Size in Visual Field Progression in Glaucoma

PurposeTo investigate the correlation between optic disc hemorrhage (DH) size and glaucoma progression. DesignA retrospective observational cohort study MethodsXXXX SettingA single tertiary hospital in South Korea Study PopulationTwo hundred and fifty (250) open-angle glaucoma (OAG) patients with DH. Participants were followed for 5 years or longer, with a minimum of 5 visual field (VF) tests. Observation ProcedureThe DH area was calculated by comparing the pixel numbers of the DH area with the disc area based on optical coherence tomography (OCT). For recurrent DH cases, we calculated the average DH area. DH size was classified as large or small based on the median value. Rates of mean deviation (MD) loss were determined using Guided Progression Analysis (GPA). Univariable and multivariable regression analyses were performed to identify significant predictors of MD loss. Main outcome measuresDH size and longitudinal VF progression ResultsThe mean follow-up period was 11.1 ± 3.6 years. The group with large DH showed faster global MD loss relative to the group with small DH (-0.51±0.48 dB/y vs. -0.36±0.42 dB/y, p = 0.01). In the multivariable model, mean DH size, maximum DH size, and initial MD were all significantly associated with the overall rate of MD loss (all p < 0.05). ConclusionsDH size was associated with the rate of VF deterioration. Eyes with larger DH showed more pronounced VF progression.

Evaluation of cerebrovascular events via retinal angiography during transcatheter aortic valve implantation

Objectives Patients receiving transcatheter aortic valve implantation (TAVI) are elderly with multiple comorbidities and at increased risk of perioperative cerebrovascular events. Retinal vasculature represents a surrogate of central nervous system circulation and is noninvasively achievable by retinal imaging. The aim of this study was to evaluate the applicability of retinal angiography of microvascular complications and association to cerebral ischemic events during TAVI. Design One hundred patients (male 54%, age: median 82 years, range 64–95 years) undergoing TAVI were recruited for this study. Imaging of retinal vasculature was evaluated with a handheld fundus camera before, during and 1 month after. Cerebrovascular events were determined as a part of contemporary clinical evaluation with cerebral CT and CTA imaging when symptoms occurred. Results Altogether 66/100 patients (66%) were included in the analysis. In-hospital ischemic event (transient ischemic attack, cerebral infarction) was observed in 1/66 patient (1.5%). Retinal vascular abnormalities occurred in 8/66 patients (12.1%); 4/66 patients (6.1%) were detected with a cholesterol plaque in the retinal artery, 2/66 (3%) a capillary leakage, 1/66 (1.5%) and optic disk hemorrhage and 1/66 (1.5%) a macular bleeding. No significant association between retinal vasculature abnormalities and cerebrovascular events was detected mainly due to the low event rate. Conclusions Perioperative evaluation of cerebrovascular ischemia with noninvasive imaging of retinal vasculature is possible in most patients undergoing TAVI. More data is needed to evaluate the association of cerebrovascular events and retinal microvascular abnormalities during the procedure.

Decision Factors for Glaucoma Suspects and Ocular Hypertensive Treatment at an Academic Center.

Practice guidelines assert that high-risk glaucoma suspects should be treated. Yet, there is ambiguity regarding what constitutes a high enough risk for treatment. The purpose of this study was to determine which factors contribute to the decision to treat glaucoma suspects and ocular hypertensive patients in an academic ophthalmology practice. Retrospective cohort study of glaucoma suspects or ocular hypertensives at an academic ophthalmology practice from 2014 to 2020. Demographics, comorbidities, intraocular pressure (IOP), optical coherence tomography (OCT) findings, and visual field measurements were compared between treated and untreated patients. A multivariable logistic regression model assessed predictors of glaucoma suspected treatment. Of the 388 patients included, 311 (80%) were untreated, and 77 (20%) were treated. There was no statistical difference in age, race/ethnicity, family history of glaucoma, central corneal thickness (CCT), or any visual field parameters between the two groups. Treated glaucoma suspects had higher IOP, thinner retinal nerve fiber layers (RNFL), more RNFL asymmetry, thinner ganglion cell-inner plexiform layers (GCIPL), and a higher prevalence of optic disc drusen, disc hemorrhage, ocular trauma, and proliferative diabetic retinopathy (PDR) (p < 0.05 for all). In the multivariable model, elevated IOP {odds ratio [OR] 1.16 [95% confidence interval (CI) 1.04-1.30], p = 0.008}, yellow temporal [5.76 (1.80-18.40), p = 0.003] and superior [3.18 (1.01-10.0), p = 0.05] RNFL quadrants, and a history of optic disc drusen [8.77 (1.96-39.34), p = 0.005] were significant predictors of glaucoma suspect treatment. Higher IOP, RNFL thinning, and optic disc drusen were the strongest factors in the decision to treat a glaucoma suspect or ocular hypertensive patient. RNFL asymmetry, GCIPL thinning, and ocular comorbidities may also factor into treatment decisions. Understanding the clinical characteristics that prompt glaucoma suspect treatment helps further define glaucoma suspect disease status and inform when treatment should be initiated. Ciociola EC, Anderson A, Jiang H, et al. Decision Factors for Glaucoma Suspects and Ocular Hypertensive Treatment at an Academic Center. J Curr Glaucoma Pract 2023;17(3):157-165.

Deep Learning for Localized Detection of Optic Disc Hemorrhages

To develop an automated deep learning system for detecting the presence and location of disc hemorrhages in optic disc photographs. Development and testing of a deep learning algorithm. Optic disc photos (597 images with at least 1 disc hemorrhage and 1075 images without any disc hemorrhage from 1562 eyes) from 5 institutions were classified by expert graders based on the presence or absence of disc hemorrhage. The images were split into training (n=1340), validation (n=167), and test (n=165) datasets. Two state-of-the-art deep learning algorithms based on either object-level detection or image-level classification were trained on the dataset. These models were compared to one another and against 2 independent glaucoma specialists. We evaluated model performance by the area under the receiver operating characteristic curve (AUC). AUCs were compared with the Hanley-McNeil method. The object detection model achieved an AUC of 0.936 (95% CI=0.857-0.964) across all held-out images (n=165 photographs), which was significantly superior to the image classification model (AUC=0.845, 95% CI=0.740-0.912; P=.006). At an operating point selected for high specificity, the model achieved a specificity of 94.3% and a sensitivity of 70.0%, which was statistically indistinguishable from an expert clinician (P=.7). At an operating point selected for high sensitivity, the model achieves a sensitivity of 96.7% and a specificity of 73.3%. An autonomous object detection model is superior to an image classification model for detecting disc hemorrhages, and performed comparably to 2 clinicians.

Prevalence of glaucomatous-appearing discs in patients undergoing artificial intelligence screening for diabetic retinopathy

PurposeTo determine the prevalence of optic disc changes suspicious for glaucoma (OCSG) which may be overlooked by artificial intelligence-based diabetic retinopathy (DR) screening systems in place of in-person dilated screening exams. MethodsThis was a retrospective cross-sectional study. High-resolution images were retrieved for 677 consecutive automated DR screening exams performed in adult patients. These were reviewed by two blinded readers for evidence of OCSG, which included increased vertical cup-to-disc ratio (VCDR), beta-zone peripapillary atrophy, optic disc hemorrhage, vessel bayoneting, rim thinning, and/or central vessel nasalization. The prevalence of OCSG was reported and compared between subjects designated as referable versus non-referable for DR. ResultsIn total, 823 eyes of 413 subjects were included. The total OCSG prevalence was 4.8% to 20.6%, with no statistically significant difference between patients designated referable versus non-referable on artificial intelligence-based DR screening. The combined classification reliability of the image readers was moderate to substantial compared to a glaucoma specialist. ConclusionsOCSG were detected in 4.8% to 20.6% of adult diabetic patients who underwent AI-based DR screening in our cohort. This represents a significant prevalence of optic disc findings which, if detected on manual screening, would have prompted referral for a glaucoma workup. Such findings illustrate the need for artificial intelligence-based screening platforms which cover multiple high-prevalence ophthalmic conditions. Replacing manual dilated screening exams with systems optimized for a single disease may increase the risk of missing comorbid ocular disease.

Ocular Manifestations Associated with Cerebral Vein Sinus Thrombosis Developing after SARS-CoV-2 Vaccination

Purpose: We report a case of neuroretinitis combined with external ophthalmoplegia in a patient who developed a cerebral venous sinus thrombosis after administration of a SARS-CoV-2 vaccine.Case summary: A 26-year-old woman who was on oral contraceptives was diagnosed with a cerebral venous sinus thrombosis 1 month after the first injection of a SARS-CoV-2 vaccine (BNT162b2, Pfizer-BioNTech). The levels of factors 8 and 9 were elevated on the blood test. The corrected visual acuities were 0.3 in both eyes. A complete limitation of abduction and esotropia were evident in the left eye. Both eyes exhibited optic disc swelling and hemorrhage and retinal nerve fiber layer swelling. Subretinal fluid was apparent in the right eye. Three weeks later, the optic disc swellings and hemorrhages had worsened and both eyes evidenced macular stars. After 10 months, the corrected visual acuities improved to 0.9 in both eyes. Ocular motor function and the esotropia also improved. However, the overall contraction of the visual field did not.Conclusions: SARS-CoV-2 vaccination can trigger cerebral venous sinus thrombosis, neuroretinitis, and external ophthalmoplegia. In patients with risk factors for such thrombosis, the possibility of ophthalmic complications should be considered after administration of a SARS-CoV-2 vaccine.

The application of artificial intelligence in glaucoma diagnosis and prediction.

Artificial intelligence is a multidisciplinary and collaborative science, the ability of deep learning for image feature extraction and processing gives it a unique advantage in dealing with problems in ophthalmology. The deep learning system can assist ophthalmologists in diagnosing characteristic fundus lesions in glaucoma, such as retinal nerve fiber layer defects, optic nerve head damage, optic disc hemorrhage, etc. Early detection of these lesions can help delay structural damage, protect visual function, and reduce visual field damage. The development of deep learning led to the emergence of deep convolutional neural networks, which are pushing the integration of artificial intelligence with testing devices such as visual field meters, fundus imaging and optical coherence tomography to drive more rapid advances in clinical glaucoma diagnosis and prediction techniques. This article details advances in artificial intelligence combined with visual field, fundus photography, and optical coherence tomography in the field of glaucoma diagnosis and prediction, some of which are familiar and some not widely known. Then it further explores the challenges at this stage and the prospects for future clinical applications. In the future, the deep cooperation between artificial intelligence and medical technology will make the datasets and clinical application rules more standardized, and glaucoma diagnosis and prediction tools will be simplified in a single direction, which will benefit multiple ethnic groups.

E-Net: a novel deep learning framework integrating expert knowledge for glaucoma optic disc hemorrhage segmentation

E-Net: a novel deep learning framework integrating expert knowledge for glaucoma optic disc hemorrhage segmentation

Cessation of Recurrent Bilateral Optic Disc Haemorrhages after Successful Trabeculectomy: A Case Report

Purpose: To describe a patient with primary open-angle glaucoma in whom bilateral recurrent optic disc haemorrhages disappeared permanently after trabeculectomy. Methods: A 67-old male patient was diagnosed with primary open-angle glaucoma and was followed for 10 years including best corrected visual acuity, visual field examinations, slit lamp examinations, Goldmann applanation tonometry, fundoscopy and optic disc photographs. Results: Optic disc haemorrhages were detected in 8 out of 30 preoperative visits in the right eye and in 3 out of 19 visits in the left eye. Trabeculectomy with intraoperative application of mitomycin C was performed in both eyes due to the advanced visual field loss with an inadequate intraocular pressure control despite maximum-tolerated medical therapy and because of the recurrent optic disc haemorrhages. No further optic disc haemorrhages were observed in either eye after trabeculectomy. Conclusion: Our case report demonstrates that recurrent bilateral optic disc haemorrhages can cease permanently after successful trabeculectomy.

Vascular parameters and endothelin-1 measurements in glaucoma patients with low- and high-tension optic disc hemorrhages

This prospective study aimed to compare vascular parameters (endothelin-1 [ET-1] blood levels, laser Doppler imaging [LDI] of distal phalanxes, and nailfold capillaroscopy) between open-angle glaucoma patients with low- and high-tension optic disc hemorrhages (LTDH and HTDH, respectively). The 33 enrolled patients (mean age, 62.3 ± 13 years) were classified as LTDH or HTDH if they presented at the time of DH detection an intraocular pressure (IOP) < 16 mmHg or ≥ 16 mmHg, respectively. Demographic and ophthalmological data, ET-1 concentrations, LDI (before and 1, 10, and 20 min after cold stimulation), and nailfold capillaroscopy findings were evaluated. The ET-1 blood level was 65% higher in the LTDH (2.27 ± 1.46 pg/ml) than in the HTDH (1.37 ± 0.57 pg/ml; p = 0.03) group. Moreover, there was a statistically significant negative correlation between ET-1 blood concentration and IOP at the time of DH detection (r = −0.45, p = 0.02). Blood flow measurements 10 and 20 min after cold stimulation were lower in the LTDH group than in the HTDH group (p < 0.01). Patients developing DH with lower IOPs have higher ET-1 blood levels and more peripheral vascular dysfunction as estimated by LDI than those with higher IOPs. These findings suggest that distinct underlying mechanisms may be involved in patients developing DH within different IOP ranges.

Comparison of posterior vitreous detachment-related and glaucomatous optic disc hemorrhage

This study compared the characteristics of posterior vitreous detachment (PVD)-related and glaucomatous optic disc hemorrhage (DH). Fundus photographs of eyes with PVD-related DH (PVD group) and glaucomatous DH (glaucoma group) were reviewed. The shape, type, layer, location (clock-hour sector), and DH/disc area (DH/DA) ratio of DH were investigated. In the PVD group, DH presented as a flame (60.9%), splinter (34.8%), and dot or blot (4.3%) shape. However, most of the glaucomatous DH revealed a splinter shape (92.3%), followed by a flame shape (7.7%, p < 0.001). In the PVD group, the most common type of DH was cup margin type (52.2%), whereas, in the glaucoma group it was disc rim type (53.8%, p = 0.003). Both PVD-related and glaucomatous DH were most commonly observed in the 7 o’clock sector. In the PVD group, DH was also found in the 2 and 5 o’clock sectors (p = 0.010). Mean DH/DA ratio in PVD group (0.15 ± 0.19) was greater than in glaucoma group (0.04 ± 0.04, p < 0.001). PVD-related DH showed a higher frequency of flame shape, cup margin type, nasal location, and greater area compared to the glaucomatous DH.