Optic Disc Hemorrhage May Be Associated with Retinal Nerve Fiber Loss in Otherwise Normal Eyes

Jeoung, Jin Wook; Park, Ki Ho; Kim, Joon Mo; Kang, Shin Hee; Kang, Ja Heon; Kim, Tae-Woo; Kim, Dong Myung

doi:10.1016/j.ophtha.2008.08.024

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Volume 115, Issue 12 , Pages 2132-2140, December 2008

Optic Disc Hemorrhage May Be Associated with Retinal Nerve Fiber Loss in Otherwise Normal Eyes

Jin Wook Jeoung, MD
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
Ki Ho Park, MD
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence: Ki Ho Park, MD, Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
Joon Mo Kim, MD
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Shin Hee Kang, MD
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
Ja Heon Kang, MD
- Department of Ophthalmology, East-west Neo Medical Center, Seoul, Korea
Tae-Woo Kim, MD
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
Dong Myung Kim, MD
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

Received 11 March 2008; received in revised form 7 July 2008; accepted 8 August 2008.

Purpose

To evaluate quantitatively the structural damage of the peripapillary retinal nerve fiber layer (RNFL) in eyes with disc hemorrhage (DH).

Design

Prospective cross-sectional study.

Participants

Seventy patients with DH (70 eyes; mean age ± standard deviation, 60.0±11.8 years) and 100 healthy control subjects (100 eyes; mean age ± standard deviation, 57.7±8.0 years) were enrolled from the Glaucoma Clinic of Seoul National University Hospital.

Methods

Normal eyes without DH (group 1: normal control group) served as controls. Eyes with DH were divided into the following groups: (1) eyes with a DH, accompanied by no visible RNFL defect according to red-free fundus photography and normal visual fields (group 2: DH only group); (2) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by normal visual fields (group 3: DH-preperimetric group); and (3) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by glaucomatous visual field defect in the corresponding hemifield location (group 4: DH-perimetric group). Optical coherence tomography (OCT)-measured RNFL thicknesses were compared.

Main Outcome Measures

Average and segmental (4 quadrants and 12 clock-hours) OCT-measured RNFL thicknesses.

Results

The number of eyes in groups 1, 2, 3, and 4 was 100, 25, 22, and 23 eyes, respectively. The OCT-measured RNFL thickness was significantly different among the 4 groups in average RNFL thickness and in inferior, superior, and nasal quadrants (P<0.01, 1-way analysis of variance). On post hoc analysis, the eyes of groups 2 and 3 showed thinner average RNFL thickness than those of group 1, and the average RNFL thickness of group 4 was significantly lower than that of groups 2 and 3 (P<0.001, 1-way analysis of variance and Tukey's test). The OCT-measured RNFL thickness revealed a topographic relationship with the DH location.

Conclusions

Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that preperimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or preperimetric RNFL loss in the eyes with DH.