title: Optical coherence tomography shows progressive local nerve fiber loss after disc hemorrhages in glaucoma patients.
abstract: OBJECTIVE
  The aim of this work is to investigate whether optic disc hemorrhages (ODH) lead to significant loss of nerve fibers at the lesion site over time and whether such a loss is reflected by visual field defects corresponding to the affected nerve fiber bundle.
  
  
  METHODS
  In this retrospective study of ten sequential glaucoma patients (ten eyes) with ODH, we used high-resolution OCT circular scans (Spectralis HRA + OCT, Heidelberg Engineering, Heidelberg, Germany) to determine peripapillary retinal nerve fiber layer (RNFL) thickness at the time of ODH presentation and at follow-up visit between 3 and 6 months. Corresponding perimetric data were analyzed for global (mean defect, MD) and localized progression of visual field defects.
  
  
  RESULTS
  ODH were mostly located in the inferior quadrant as determined clinically and from fundus photographs. Iterative OCT imaging revealed a significant RNFL reduction in the affected quadrant relative to the respective quadrant in the fellow eye (RNFL change = -2.25 ± 2.69 μm vs. 0.75 ± 2.78 μm, p = 0.01) within 120 ± 43 days. However, only three cases presented with new/progressive nerve fiber bundle defects corresponding to the lesion site within the given follow-up period.
  
  
  CONCLUSIONS
  ODH lead to a significantly higher RNFL loss at the lesion site relative to the overall structural progression in glaucoma patients. However, this focal change is not generally reflected by respective nerve fiber bundle defects in the time frame investigated.
authors.affiliation: University Eye Hospital, Centre for Ophthalmology, University of Tuebingen, Schleichstr 12-16, 72076, Tuebingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kernstock
authors.forename: Janko
authors.initials: J
authors.lastname: Dietzsch
authors.forename: Kai
authors.initials: K
authors.lastname: Januschowski
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schiefer
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Fischer
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014786:Vision Disorders / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology