Anatomic Relationships between Disc Hemorrhage and Parapapillary Atrophy

Purpose

Parapapillary atrophy (PPA) and disc hemorrhage (DH) are associated with glaucoma. We sought to determine whether they are anatomically related.

Design

Retrospective study.

Methods

All digital optic nerve stereophotographs obtained over a one-year period were screened for the presence of DH. Only patients with DH were included. The location of the greatest β zone PPA width as defined by the radial distance between the scleral rim and the outer border of the β zone was compared in each patient. The clock hour location of the DH was determined. Baseline central corneal thickness, intraocular pressure, vertical cup-to-disc ratio, and visual field indices were obtained.

Results

Photographs from 1,559 glaucoma patients were evaluated and 46 eyes with unilateral DH were identified; 42 (91.3%) had β zone PPA and 38 eyes had asymmetric PPA width. DH occurred more frequently in the eye with the greater PPA width (29/38 eyes [76.3%]; κ = 0.611; P < .001). The DH fell on the point of greatest PPA width in 10 (23.9%) of 42 eyes (P < .05, Fisher exact test) and within two clock hours of the greatest PPA width in 31 (73.8%) of 42 eyes (P < .001, Chi-square test). Logistic regression analysis determined that greater PPA width (odds ratio, 17.16; 95% confidence interval, 5.34 to 55.12; P < .001) was the only ocular characteristic to predict the laterality of the DH.

Conclusions

DHs tend to occur in the eye with the greatest PPA width and usually are found within the region of its greatest width.