ImportanceAlthough optic disc hemorrhage (DH) is widely recognized as a glaucoma risk factor, its clinical relevance in relation to proximity has not been investigated.ObjectiveTo determine the association of the proximal location of DH with glaucoma progression.Design, Setting, and ParticipantsIn this longitudinal observational cohort study, 146 eyes of 146 patients at Seoul National University Hospital who had had 1 or more DH with at least 5 years of follow-up and had at least 5 reliable visual field examinations were included. These data were analyzed January 10, 2010, through June 27, 2017.ExposuresLaminar, marginal, rim, and parapapillary subtypes of DH were identified based on their respective proximal locations. The laminar and marginal subtypes were classified into the cup-type group, while the rim and parapapillary subtypes were classified into the peripapillary-type group. Kaplan-Meier survival analysis was used to compare survival experiences and multivariate analysis with the Cox proportional hazard model to identify risk factors for glaucoma progression. Regression analyses, both univariate and multivariate, were used to discover significant indicators of mean deviation (MD) loss.Main Outcome and MeasureThe primary outcome was glaucoma progression. Glaucoma progression was defined either as structural or functional deterioration.ResultsFor all of the eyes, the mean follow-up period was 10.9 (3.7) years (range, 5.1-17.8 years), the mean age at which DH was first detected was 55.1 (11.3) years (range, 21-77 years), and 94 participants were female (64.1%). Over the mean follow-up period of 10.9 years, glaucoma progression was detected in 94 eyes (61.4%) with an MD change of −0.48 dB per year. The cup-type group showed a faster rate of MD change relative to the peripapillary-type group (−0.56 vs −0.32 dB per year; difference = −0.24; 95% CI, −0.37 to −0.11; P = .01). The cup group showed a higher cumulative probability of progression of glaucoma (80.4%) relative to the peripapillary group (54.4%; difference = 26.0%; 95% CI, 11.4%-40.6%; P < .001) in a life table analysis. The presence of cup hemorrhage was associated with an increased risk of glaucoma progression (hazard ratio, 3.28; 95% CI, 2.12-5.07; P < .001) in the multivariate Cox proportional hazard model. Cup-type DH was associated to MD loss rate in regression analysis.Conclusions And RelevanceThis study showed glaucoma progression was higher in cases of DH classified as the cup type. These findings support the potential utility of assessing the proximal location of DH to predict how glaucoma might progress.

中文翻译：

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视盘出血和青光眼进展的近端位置


重要性尽管视盘出血 （DH） 被广泛认为是青光眼的危险因素，但其与邻近性相关的临床相关性尚未得到调查。目的确定 DH 近端位置与青光眼进展的关系。设计、设置和参与者在这项纵向观察队列研究中，首尔国立大学医院 146 名患者的 146 只眼睛被纳入，这些患者接受过 1 次或多次 DH 治疗，随访至少 5 年，并且至少有 5 次可靠的视野检查。这些数据于 2010 年 1 月 10 日至 2017 年 6 月 27 日进行了分析。层状和边缘亚型分为杯型组，边缘和旁亚型分为周围型组。采用 Kaplan-Meier 生存分析比较生存经历，采用多变量分析与 Cox 比例风险模型，以确定青光眼进展的危险因素。使用单变量和多变量回归分析来发现平均偏差 （MD） 损失的重要指标。主要结局和测量主要结局是青光眼进展。青光眼进展被定义为结构或功能恶化。结果对于所有眼睛，平均随访期为 10.9 （3.7） 年 （范围，5.1-17.8 岁），首次检测到 DH 的平均年龄为 55.1 （11.3） 岁 （范围，21-77 岁），94 名参与者为女性 （64.1%）。在 10.9 年的平均随访期内，在 94 只眼 （61.4%） 中检测到青光眼进展，MD 变化为每年 -0.48 dB。 杯型组相对于周围型组显示出更快的 MD 变化率（每年 -0.56 vs -0.32 dB;差异 = -0.24;95% CI，-0.37 至 -0.11;P = .01）。相对于周围组 （54.4%;差异 = 26.0%;95% CI，11.4%-40.6%;P < .001） 的分析。杯出血的存在与青光眼进展风险增加相关 （风险比，3.28;95% CI，2.12-5.07;P < .001） 在多变量 Cox 比例风险模型中。在回归分析中，杯型 DH 与 MD 丢失率相关。结论和相关性这项研究表明，在被归类为杯型的 DH 病例中，青光眼进展更高。这些发现支持评估 DH 的近端位置以预测青光眼可能如何进展的潜在效用。