Disc haemorrhages in Polish Caucasian patients with normal tension glaucoma.

AIM

The aim of this observational study was to evaluate the epidemiology of disc haemorrhages (DH) in Polish patients with normal tension glaucoma (NTG) and their association with some risk factors.

MATERIAL AND METHODS

The group studied consisted of 274 Caucasian patients with NTG (410 eyes) divided into those with disk haemorrhages (DH+, = 94 eyes in 81 patients) and those without disc haemorrhages (DH-, = 316 eyes in 193 patients). Ophthalmic examinations with visual field (VF) testing were carried out in these patients every 3 months for at least 18 months. The medical history was recorded taking glaucoma, other ophthalmic diseases, chronic general disorders and vascular risk factors into account.

RESULTS

Unilateral and bilateral DH were observed more frequently in women (p = 0.0010). Maximum IOP was significantly higher in the DH+ group (p = 0.000026). Notches and peripapillary atrophy were found with similar frequency in DH+ and DH- patients (p = 0.4631). The mean defect (MD) in the VF at the time of diagnosis was lower in the DH+ group (-6.27 dB) than in the DH group (-10.14 dB), (p = 0.000055). The initial MD in the DH+ group had a positive correlation with maximum initial IOP. A progressive loss of VF was observed in 206 eyes with NTG (50.2%), with a mean of 0.72 dB/year. The progression was more frequent in DH+ patients (78.4% versus 41.1%), but there were no statistically significant differences in the rate of progression between DH+ and DH- patients (p = 0.46). The morphology of early scotoma depended on the presence of DH (p < 0.00001), and early scotoma in the DH+ group was more frequently localized paracentrally. There was a significant difference in a number of antiglaucoma drops between DH+ and DH- patients (p < 0.00001). There were no differences in the frequency of migraines between both groups (p = 0.31). General hypotension was observed with similar frequency in the DH+ DH- groups (p = 0.3). General hypertension was less frequent in DH+ patients (p = 0.041), especially in women (p = 0.000027). Diabetes mellitus (DM) was significantly less frequent (21.3%) in patients with DH+ (3.7%) than in the DH- group (p = 0.000852), especially among the women (p = 0.000216).

CONCLUSION

In our study, DH were more frequent both unilaterally and bilaterally in women. Initial intraocular pressure (IOP) was higher in NTG patients with DH, and early scotoma was localized in the paracentral area of the VF. Disc haemorrhages (DH) were less frequent in women with general hypertension and with diabetes mellitus.