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.