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Editors Selection IGR 17-3

Clinical glaucoma: Disc hemorrhages

Comment by Jost Jonas on:

13854 Incidence of disc hemorrhages in open-angle glaucoma before and after trabeculectomy, Miyake T; Sawada A; Yamamoto T et al., Journal of Glaucoma, 2006; 15: 164-171

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In a clinical interventional study, Miyake et al. (464) determined the frequency of detected optic disc hemorrhages in 99 patients with primary open-angle glaucoma and 50 patients with normal-pressure glaucoma before and after surgical reduction of intraocular pressure from 19.6 &plm; 4.4 mmHg to 11.1 &plm; 4.2 mmHg and from 15.3 &plm; 1.5 mmHg to 11.3 &plm; 4.4 mmHg, respectively. After surgery, the final cumulative probability of detecting a disc hemorrhages significantly decreased from 33.4 &plm; 7.8% to 5.5 &plm; 2.2% in the primary open-angle glaucoma group, and from 42.1 &plm; 8.8% to 23.1 &plm; 6.3% in the normal-pressure glaucoma group. This study confirms previous investigations which strongly support that a reduction in intraocular pressure decreases the risk of further progression of high-pressure glaucoma as well as normal-pressure

The incidence of disc hemorrhages decreased after surgery

glaucoma. It extends the findings of the previous studies on the frequency of detected disc hemorrhages which have been considered to be one of the strongest predictive factors for progressive loss in visual field in glaucoma. In addition, patients from both study groups with disc hemorrhages prior to the surgical reduction in IOP tended to show a re-appearance of the disc hemorrhages after surgery. The meaning of this observation has remained unclear so far. One may hypothesize that detected disc hemorrhages tend to occur in a particular subgroup of patients with glaucoma ('the bleeders') who may, or may not, exhibit special characteristics of the pathophysiology of glaucomatous optic neuropathy.

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