Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma

Author(s): Akagi T (1), Zangwill LM (2), Saunders LJ (2), Yarmohammadi A (2), Manalastas PIC (2), Suh MH (3), Girkin CA (4), Liebmann JM (5), Weinreb RN (6)

1 Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
2 Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California.
3 Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California; Haeundae Paik Hospital, Inje University, Busan, South Korea.
4 Department of Ophthalmology, University of Alabama, Birmingham, Alabama.
5 Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York.
6 Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California. Electronic address: rweinreb@ucsd.edu.

PURPOSE: To investigate longitudinal temporal and spatial associations between disc hemorrhage (DH) and rates of local retinal nerve fiber layer (RNFL) thinning before and after DHs.

DESIGN: Longitudinal, observational cohort study.

PARTICIPANTS: Forty eyes of 37 participants (23 with glaucoma and 17 with suspect glaucoma at baseline) with DH episodes during follow-up from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.

METHODS: All subjects underwent optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were calculated using multivariate linear mixed-effects models before and after DH.

MAIN OUTCOME MEASURES: Rates of global and local RNFL thinning.

RESULTS: Thirty-six eyes of 33 participants with inferior or superior DHs were analyzed. The rates of RNFL thinning were significantly faster in DH quadrants than in non-DH quadrants after DH (-2.25 and -0.69 μm/year; P < 0.001). In the 18 eyes with intensified treatment after DH, the mean rate of RNFL thinning significantly slowed after treatment compared with before treatment in the non-DH quadrants (-2.89 and -0.31 μm/year; P < 0.001), but not in the DH quadrants (-2.64 and -2.12 μm/year; P = 0.19). In 18 eyes with unchanged treatment, the rate of RNFL thinning in the DH quadrant was faster after DH than before DH (P = 0.008). Moreover, compared with eyes without a treatment change, intensification of glaucoma treatment after DH significantly reduced the global, non-DH quadrants, and DH quadrant rates of RNFL thinning after DH compared with before DH (global, P = 0.004; non-DH quadrant, P < 0.001; DH quadrant, P = 0.005). In the multiple linear regression analysis, treatment intensification (β, 1.007; P = 0.005), visual field mean deviation (β, 0.066; P = 0.049), and difference in intraocular pressure before and after DH (β, -0.176; P = 0.034) were associated significantly with the difference of global RNFL slope values before and after DH.

CONCLUSIONS: Although the rate of RNFL thinning worsened in a DH quadrant after DH, glaucoma treatment intensification may have a beneficial effect in reducing this rate of thinning.

Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Ophthalmology. 2017 Sep;124(9):1403-1411. doi: 10.1016/j.ophtha.2017.03.059. Epub 2017 May 9.

PMID: 28499748

http://www.ncbi.nlm.nih.gov/pubmed/28499748

Clinical Paper of the Month manager: Andreas Boehm