Siegner S W, Netland P A
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Ophthalmology. 1996 Jul;103(7):1014-24. doi: 10.1016/s0161-6420(96)30572-1.
To assess progressive changes of the optic nerve head and visual fields in patients with glaucoma and ocular hypertension after optic disc hemorrhage.
The authors reviewed the charts of 91 patients with 121 disc hemorrhages who had a mean follow-up of 41.9 +/- 3.6 months. The frequency of visual field and optic nerve head changes in these patients was studied.
The mean intraocular pressure at the examination when the disc hemorrhage was noted was 18.9 +/- 0.5 mmHg. Overall, 64 (63%) of 101 eyes showed progressive changes of visual fields after disc hemorrhage, compared with 24 (24%) of 101 control eyes (P < 0.0005). Similarly, 56 (79%) of 71 eyes showed progressive changes of optic nerve head contour by masked evaluation of stereophotographs, compared with 16 (22%) of 71 control eyes (P < 0.0005). Eyes with disc hemorrhage showed significantly greater progression of visual field defects in patients with open-angle glaucoma (P < 0.001), low-tension glaucoma (P < 0.05), and ocular hypertension (P = 0.0067) compared with control eyes matched by age, follow-up time, and diagnosis. Similarly, progressive changes of optic nerve head contour were observed more often in eyes after disc hemorrhage in patients with open-angle glaucoma (P < 0.0005), low-tension glaucoma (P < 0.025), and ocular hypertension (P < 0.005), compared with controls. The mean time interval to progression after disc hemorrhage was observed was 16.8 +/- 2.0 months for visual field changes and 23.8 +/- 2.9 months for optic nerve head changes. In eyes with disc hemorrhage, 27 (22%) of 121 had recurrent hemorrhages at a mean interval of 21.5 +/- 2.9 months after previous hemorrhage. The most common site of disc hemorrhage was the inferotemporal quadrant. Eyes with disc hemorrhage that occurred on the temporal side of the optic nerve head had a significantly lower intraocular pressure (P < 0.02) and greater progressive changes of the optic discs (P < 0.001) compared with eyes with hemorrhage on the nasal side.
The authors' results indicate that disc hemorrhages in eyes with glaucoma or ocular hypertension often are associated with progressive changes of the optic nerve head and visual fields.
评估青光眼和高眼压症患者视盘出血后视神经乳头和视野的进展性变化。
作者回顾了91例患者121次视盘出血的病历，这些患者平均随访时间为41.9±3.6个月。研究了这些患者视野和视神经乳头变化的频率。
发现视盘出血时检查的平均眼压为18.9±0.5 mmHg。总体而言，101只眼中有64只（63%）在视盘出血后出现视野进展性变化，而101只对照眼中有24只（24%）出现这种情况（P<0.0005）。同样，通过立体照片的盲法评估，71只眼中有56只（79%）出现视神经乳头轮廓的进展性变化，而71只对照眼中有16只（22%）出现这种情况（P<0.0005）。与年龄、随访时间和诊断相匹配的对照眼相比，开角型青光眼（P<0.001）、低眼压性青光眼（P<0.05）和高眼压症（P = 0.0067）患者中，视盘出血的眼视野缺损进展明显更大。同样，与对照组相比，开角型青光眼（P<0.0005）、低眼压性青光眼（P<0.025）和高眼压症（P<0.005）患者视盘出血后，视神经乳头轮廓的进展性变化在眼中更常观察到。视盘出血后观察到视野变化进展的平均时间间隔为16.8±2.0个月，视神经乳头变化为23.8±2.9个月。在视盘出血的眼中，121只中有27只（22%）出现复发性出血，上次出血后平均间隔时间为21.5±2.9个月。视盘出血最常见的部位是颞下象限。与鼻侧出血的眼相比，视神经乳头颞侧发生视盘出血的眼眼压明显更低（P<0.02），视盘进展性变化更大（P<0.001）。
作者的结果表明，青光眼或高眼压症患者眼中的视盘出血通常与视神经乳头和视野的进展性变化相关。
