Ocular and systemic risk factors associated with recurrent disc hemorrhage in primary open-angle glaucoma

PURPOSE: To evaluate the risk factors associated with recurrent disc hemorrhage (DH), defined for the present study as at least 3 occurrences of DH in primary open-angle glaucoma (POAG). METHODS: A total of 178 POAG patients (89 eyes showing at least 3 occurrences of DH and 89 age-matched control eyes with a minimum of 10 years’ follow-up without DH) were included in a retrospective, case-control study. Ocular factors were evaluated by a retrospective chart review, and systemic factors were evaluated by a telephone survey. Associations between factors and recurrent DH were investigated by logistic regression analysis. The Kaplan–Meier survival analysis and Cox proportional-hazards regression models were used to evaluate glaucoma progression and to identify the factors predictive of glaucoma progression. RESULTS: Univariate regression analysis revealed the association of recurrent DH with low baseline intraocular pressure (IOP) [odds ratio (OR), 0.88; 95% confidential interval (CI), 0.80–0.98; P = 0.014], lower percentage reduction of IOP (OR, 0.96; 95% CI, 0.93–0.99; P = 0.020), cold extremities (OR, 2.80; 95% CI, 1.03–7.60; P = 0.043), prone or lateral decubitus sleeping position (OR, 2.14; 95% CI, 1.13–4.03; P = 0.019), and sleeping disorders (OR, 2.33; 95% CI, 1.05–5.15; P = 0.037). Multivariate regression analysis revealed that a lower percentage reduction in IOP (OR, 0.96; 95% CI, 0.93–1.00; P = 0.046) increased the risk of recurrent DH. The control group exhibited a greater cumulative probability of non-progression than the recurrent DH group (P = 0.01, by log-rank test). The Cox proportional-hazards regression model showed that recurrent DH was associated with glaucoma progression [hazard ratio (HR), 1.88; 95% CI; 1.66–3.05; P = 0.01. CONCLUSIONS: Among the ocular and systemic factors, only lower-percentage reduction of IOP in POAG was associated with recurrent DH. DH recurrence is associated with glaucoma progression and may be dependent on IOP.