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Editors Selection IGR 16-4

Clinical Forms of Glaucoma: ACG and disc hemorrhages

Comment by Don Budenz on:

21707 Characteristics of disc hemorrhage in primary angle-closure glaucoma, Lan YW; Wang IJ; Hsiao YC et al., Ophthalmology, 2008; 115: 1328-1333

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In this retrospective chart review, Lan et al. (1115) identified 44 patients with non-acute angle-closure glaucoma out of a total of 770 patients with angleclosure glaucoma who had optic disc hemorrhages observed at some point in follow-up by a clinician. They found that 5.7% of patients with non-acute angle-closure glaucoma developed at least one optic disc hemorrhage at some point during follow- up, which averaged approximately nine years. In addition to characterizing the location and frequency of hemorrhages, they did a sub-analysis of 14 of the 30 patients who only developed a hemorrhage in one eye and compared the glaucoma progression in that eye with the eye that did not develop a hemorrhage.

5.7% of patients with non-acute angle closure glaucoma developed at least one optic disc hemorrhage at some point during follow-up, which averaged approximately 9 years

The additional 16 patients with unilateral hemorrhage were not analyzed due to poor visual field data. This analysis suggested that eyes with hemorrhages had more visual field progression. The number of subjects from which the authors draw conclusions is rather small. In addition, the study suffers from its retrospective design and the fact that observations were based on clinical observations rather than photographs, both of which could introduce bias. This also makes it difficult to compare the authors' findings with those of other studies. Some of these limitations are addressed in the discussion. The recommendation that clinicians should look for optic disc hemorrhages in patients with non-acute angle closure glaucoma, which is a group that has not been well-characterized in this regard, is well taken.

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