%0 Journal Article
%T Optic Disc Hemorrhage after Phacoemulsification in Patients with Glaucoma
%A Karine D. Bojikian
%A Daniel B. Moore
%A Philip P. Chen
%A Mark A. Slabaugh
%J ISRN Ophthalmology
%D 2014
%R 10.1155/2014/574054
%X Background. Optic disk hemorrhage is known to be a risk factor for glaucoma progression. Cataract surgery by phacoemulsification results in large intraocular pressure fluctuations. We aim to investigate whether phacoemulsification is associated with optic disc hemorrhage in patients with glaucoma. Methods. This is a retrospective review of consecutive university clinic based glaucoma patients undergoing phacoemulsification alone, with at least 3 visits in the year before and at least 5 visits in the year following phacoemulsification. The presence of optic disk hemorrhage was evaluated with slit lamp biomicroscopy at each clinic visit prior to and following phacoemulsification. Results. We evaluated 158 eyes of 158 subjects; 15 (9.5%) had ODH noted at least once during the 2-year study period. Four eyes had ODH identified on postoperative day 1, for a cross-sectional prevalence of 2.5%. Fourteen ODH episodes were noted preoperatively versus 12 episodes postoperatively ( ). Aspirin use was associated with ODH ( ). Conclusions. Our cross-sectional study found a prevalence of ODH immediately after CE that was similar to other published rates, and our longitudinal study did not find an increase in ODH in the year after phacoemulsification when compared to the year prior to surgery. 1. Introduction Glaucoma is characterized by retinal ganglion cell degeneration, characteristic changes of the optic disc, and associated visual field loss. Elevated intraocular pressure (IOP) remains the most important known risk factor for the development and progression of glaucoma [1, 2]. Optic disc hemorrhage (ODH) has been associated with glaucoma damage and is considered to be an independent risk factor both for development and progression of the disease [3¨C5]. The etiology of ODH is poorly understood. Some authors have suggested that it represents rupture of anterior capillaries during posterior bowing of the lamina cribrosa, small infarctions in the capillaries of the optic nerve head, or other poorly defined vascular or connective tissue insults [6]. In spite of its unknown cause, multiple cross-sectional, observational, and prospective studies have identified it as an independent risk factor for progression of glaucomatous visual field loss. As a clinical sign, it remains one of the clearest indicators of optic neuropathy when caring for or identifying individuals with glaucoma. During cataract extraction by phacoemulsification (CE), high absolute IOP and large IOP fluctuations occur intraoperatively and in the early postoperative period [7, 8]. Although the long-term
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