Risk Factors for Disease Progression in Glaucoma Patients With Disk Hemorrhage.

Abstract

Prcis: Glaucoma eyes with recurrent disk hemorrhage were associated with increased systolic blood pressure and diastolic blood pressure, and increased visit-to-visit diastolic blood pressure variability was associated with glaucoma progression.

Purpose: In this study, we investigated the effects of the clinical characteristics of disk hemorrhage (DH) and hemodynamic factors on glaucoma progression.

Methods: This retrospective cohort study included 81 eyes with open angle glaucoma and nonrecurrent or recurrent DH. Recurrent DH was further classified according to the DH location. Visual field (VF) progression was determined using event-based analysis and Guided Progression Analysis software. The coefficient of variation (CV) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was used to measure visit-to-visit variability. Kaplan-Meier survival analysis was used to compare the cumulative risk ratio of progression between groups.

Results: The recurrent DH group had significantly higher SBP and DBP ( P =0.014 and=0.021, respectively) and a higher proportion of VF progression ( P =0.019) than the nonrecurrent DH group. In particular, females with recurrent DH had the highest cumulative probability of VF progression ( P =0.047, log-rank test). Recurrent DH in a different quadrant was associated with the highest cumulative probability of VF progression than nonrecurrent DH ( P =0.038, log-rank test). In Cox regression analysis, higher visit-to-visit DBP variability, female gender, and recurrent DH in a different quadrant were significantly associated with glaucoma progression.

Conclusion: In glaucomatous eyes with DH, increased visit-to-visit DBP variability was associated with glaucoma progression. Our results suggest that hemodynamic factors are involved in the recurrence of DH and progression of glaucoma.