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Gracitelli, Carolina P.B.

Mayo Clinic

Universidade Federal de São Paulo

Citations 1

Clinical Profiles of Glaucomatous Patients With High-tension and Low-tension Optic Disc Hemorrhages: A Comparative Study

Journal of Glaucoma | September 10, 2021 | Volume: 31 | Issue: 3 | Pages: 178-182

10.1097/ijg.0000000000001937 | PMID 34506356

Précis: Patients with low-tension optic disc hemorrhages (DHs) are more frequently women, have a diagnosis of normal-tension glaucoma (NTG) diagnosis and greater visual field (VF) loss. Symptoms of vascular dysregulation and Asian race also seem to be more prevalent in this clinical subtype. Purpose: Optic DH is an important glaucoma risk factor, and occurs in a wide intraocular pressure (IOP) range. We sought to characterize distinct clinical subtypes of patients with high-tension disc hemorrhage (HTDH) and low-tension disc hemorrhage (LTDH). Patients and Methods: In this cross-sectional study, treated glaucomatous patients with DHs from 2 glaucoma services were consecutively enrolled. Disc photographs were evaluated for the presence of DH by 2 glaucoma specialists. After inclusion, patients were classified on HTDH (IOP≥16 mm Hg) and LTDH (IOP<16 mm Hg; median split). Clinical and ocular data from the time of DH detection were compared between groups. Results: One hundred thirty-three DH patients were included (LTDH=66 eyes; HTDH=67 eyes). Patients with LTDH were more often women than those with HTDH (77% vs. 42%; P =0.030). There was also a trend for a higher prevalence of Asian descendants (24% vs. 9%; P =0.058) and symptoms suggestive of vascular dysregulation (34% vs. 14%; P =0.057) in LTDH patients. Eyes with LTDH also had worse VF mean deviation index ( P =0.037), higher prevalence of NTG diagnosis (46% vs. 17%; P <0.001), and tended to have thinner central corneas ( P =0.066). Conclusions: Patients developing DHs with treated IOPs in the low teens seem to more frequently fit in a profile represented by women, NTG diagnosis and greater VF loss. The presence of symptoms suggestive of vascular dysregulation and race also seem to differ between these 2 clinical subtypes. A closer optic disc surveillance is recommended for patients with the LTDH subtype, as they may develop DHs despite seemingly well-controlled IOP.