Location of Disc Hemorrhage and Direction of Progression in Glaucomatous Retinal Nerve Fiber Layer Defects

Purpose: To investigate the relationship between glaucomatous disc hemorrhage (DH) location with respect to the nasal or temporal margin of the retinal nerve fiber layer defect (RNFLD) and the direction of RNFLD widening. Materials and Methods: This is a retrospective, cross-sectional study. Patients with any documented episode of glaucomatous DH throughout the follow-up period, and definite RNFLD widening on retinal nerve fiber layer photographs were analyzed. The location of DH was recorded as either nasal or temporal, and the direction of RNFLD widening was investigated. The laterality of DH location on the RNFLD border and the direction of RNFLD widening were correlated with each other. We also compared clinical parameters between eyes with nasal versus temporal margin DHs. Results: We analyzed 123 eyes from 116 patients with definite widening of the RNFLD and glaucomatous DH at the border between the healthy and damaged retinal nerve fiber layer. The most common diagnosis was normal-tension glaucoma (109, 87.9%). The most frequent location of DH was the temporal margin of an inferotemporal RNFLD (75, 61.0%), and the most frequent pattern of change in RNFLD was temporal widening (89, 72.4%). The absolute congruency was 82.9% and the total congruency was 99.2%. No significant differences were identified between eyes with nasal versus temporal margin DHs. Conclusions: The lateral location of DH on the RNFLD border was highly congruent with the direction of RNFLD widening. This correspondence of laterality between DH development and progression of RNFLD may suggest an intimate structural relationship during the pathogenesis of DH, at the enlarging RNFLD border.