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Morphologic Predictive Factors for Development of Optic Disc Hemorrhages in Glaucoma

¹ From the Department of Ophthalmology and Eye Hospital, University Erlangen-Nürnberg, Germany; the ² Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany; and the ³ Institute of Medical Informatics, Biostatistics, and Epidemiology, Benjamin Franklin School of Medicine, Free University of Berlin, Germany.

PURPOSE. To evaluate which optic disc parameters are predictive factors for the development of disc hemorrhages in chronic open-angle glaucoma.

METHODS. The prospective comparative clinical observational study included 432 eyes of 281 white patients with chronic open-angle glaucoma. Mean follow-up time was 38.8 months (median, 31.5). Eyes in the whole study group were divided into those with an optic disc hemorrhage during the follow-up period (hemorrhagic group; n = 38; 8.8%), those without disc hemorrhages and with neuroretinal rim loss as sign of progression of glaucoma (rim loss group; n = 42; 9.7%), and those with neither disc hemorrhages nor neuroretinal rim loss (stable group; n = 352; 81.5%). Color stereo optic disc photographs were obtained repeatedly in all patients and subjected to qualitative and morphometric evaluation.

RESULTS. At baseline, neuroretinal rim area was significantly (P < 0.03) smaller and the beta zone of parapapillary atrophy (temporal lower sector) was significantly (P < 0.03) larger in the hemorrhagic group than in the stable group. Both study groups did not vary significantly (P > 0.05) in optic disc size and shape, optic cup depth, alpha zone of parapapillary atrophy, and retinal vessel diameter. In multivariate analysis, the neuroretinal rim area was the only significant predictor of hemorrhages. The hemorrhagic group and the rim loss group did not differ significantly (P > 0.05) in any optic disc parameter measured.

CONCLUSIONS. In chronic open-angle glaucoma, morphologic predictive factors for the development of disc hemorrhages are small size of neuroretinal rim and, possibly, a large parapapillary beta zone. Development of disc hemorrhages is independent of optic disc size and shape, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth. Optic nerve heads in eyes with eventual development of disc hemorrhages and in eyes with eventual progressive rim loss without observed disc hemorrhages do not differ markedly in appearance.

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