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Glaucoma Dialogue IGR 10-4

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Comment by Kenji Kashiwagi on:

22358 Disc hemorrhages and treatment in the early manifest glaucoma trial, Bengtsson B; Leske MC; Yang Z et al., Ophthalmology, 2008; 115: 2044-2048

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It has been well known that the presence of disc hemorrhage is associated with the increased likelihood of glaucoma progression. However, so far, clinical application of this knowledge has been limited because we have no sound evidence for the impact of therapeutic intervention on glaucomatous eyes with disc hemorrhages. So, it is nice for us to obtain additional information of therapeutic IOP reduction on disc hemorrhages based upon strictly designed clinical survey.
Bengtsson et al. reported that, in the Early Manifest Glaucoma Trial, IOP-reducing treatment is not associated with the presence and frequency of disc hemorrhages. Until then, as cited and discussed by the authors, some previous works reported by Hendrickx et al. (1994) and Miyake et al. (2006) have suggested that IOP reduction results in decreased frequency of disc hemorrhages. So, in an attempt to apply the present information obtained from EMGT to our daily clinical practice, we should pay attention to the discrepancy between the present and previous studies.
It may be explained by the relatively small number of cases with disc hemorrhages and/or retrospective study design in the previous study. However, I would like to point out a fact that, in EMGT, the allowed therapeutic modalities are only laser trabeculoplasty plus betaxolol. This combination is different from our recent preferred choice for the anti-glaucoma treatment, which consists of prostaglandin-related compounds as the first line drug. Also, range in IOP reduction following filtration surgery is different from that obtained after laser trabeculoplasty plus betaxolol.
Taken together into consideration, even after the present study, we would not draw decisive conclusion on the impact of IOP-lowering treatments on disc hemorrhages. However, I believe that the present results are an important process for us to establish common knowledge on the clinical features and pathogenesis of disc hemorrhages in glaucomatous optic neuropathy.

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