Ganglion Cell-inner Plexiform Layer Complex Research Articles

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma and comparison to retinal nerve fiber layers.

Evaluation of ganglion cell-inner plexiform layer thickness in the diagnosis of pre-perimetric glaucoma (PPG) and comparison to retinal nerve fiber layers. This study was a prospective hospital-based study. A total of 30 PPG and control patients were studied for retinal nerve fiber layer thickness (RNFL) and ganglion cell-inner plexiform layer complex (GC-IPL) by spectral-domain optical coherence tomography. PPG was defined as eyes with a normal visual field and one or more localized RNFL defects that were associated with a typical glaucomatous disc appearance. Diagnostic abilities of GC-IPL, optic nerve head (ONH), and RNFL parameters were computed using area under receiver-operating curve (AUROC), sensitivity, and specificity. GC-IPL parameters showed significant changes in PPG cases as compared to normal subjects in each region ( P value < 0.001). RNFL parameters also differed significantly from normal subjects in all quadrants ( P value 0.003 to < 0.001). Within GC-IPL parameters, the superotemporal region had the maximum area under the curve (AUC), followed by inferior, superior, and inferotemporal regions. Within RNFL parameters, the inferior quadrant had the maximum AUC, followed by superior and nasal quadrants. the GC-IPL parameters in PPG showed that the AUC of the GC-IPL parameters was much higher than those of the ONH and RNFL values. Although both the parameters RNFL and GC-IPL showed significant changes in PPG patients compared to healthy subjects, a higher AUC of GC-IPL points toward the higher sensitivity of GC-IPL than RNFL for detecting glaucoma in early stages.

Structural changes in the retina and serum HMGB1 levels are associated with decreased cognitive function in patients with Parkinson's disease

BackgroundCognitive impairment is a serious nonmotor symptom in patients with Parkinson's disease (PD). Currently, there are few studies investigating the relationship of serum markers and retinal structural changes with cognitive function in PD. ObjectiveTo investigate the relationship between retinal structural changes, serum high mobility group box-1 (HMGB1) levels and cognitive function and motor symptoms in PD patients. MethodsEighty-nine participants, including 47 PD patients and 42 healthy subjects, were enrolled. PD patients were divided into Parkinson's disease with normal cognitive (PD-NC), Parkinson's disease with mild cognitive impairment (PD-MCI), and Parkinson's disease with dementia (PDD) groups. The motor and nonmotor symptoms of PD patients were evaluated with clinical scale. Serum HMGB1 levels were detected by enzyme-linked immunosorbent assay (ELISA), and ganglion cell-inner plexiform layer complex (GCIPL) thickness changes in the macula were quantitatively analyzed by swept source optical coherence tomography (SS-OCT) in all patients. ResultsCompared with the control group, the macular GCIPL (t = −2.308, P = 0.023) was thinner and serum HMGB1 (z = −2.285, P = 0.022) was increased in PD patients. Macular GCIPL thickness in patients with PD-MCI and PDD were significantly lower than that in PD-NC patients, but there were no significant difference between the PD-MCI and PDD groups. Serum HMGB1 levels in patients with PD-MCI and PDD were significantly higher than those in PD-NC patients, and serum HMGB1 levels in PDD patients were higher than those in PD-MCI patients. Correlation analysis showed that serum HMGB1 levels in PD patients were positively correlated with disease duration, HY stage, UPDRS-I score, UPDRS-III score, and UPDRS total score and negatively correlated with MOCA score. Macular GCIPL thickness was negatively correlated with HY stage and positively correlated with MOCA score, and macular GCIPL thickness was negatively correlated with serum HMGB1 level. Logistic regression analysis showed that elevated serum HMGB1 level, thinner macular GCIPL thickness, and higher HY stage were independent risk factors for Parkinson's disease with cognitive impairment (PD-CI). The areas under the receiver operating characteristic curve (AUC) for the serum HMGB1 level and macular GCIPL thickness-based diagnosis of PD-MCI, PDD and PD-CI based on in patients with PD were 0.786 and 0.825, 0.915 and 0.856, 0.852 and 0.841, respectively. The AUC for the diagnosis of PD-MCI, PDD and PD-CI with serum HMGB1 level and GCIPL thickness combined were 0.869, 0.967 and 0.916, respectively. ConclusionThe macular GCIPL thickness and serum HMGB1 level are potential markers of cognitive impairment in PD patients, and their combination can significantly improve the accuracy of the diagnosis of cognitive impairment in PD.

The influence of smoking on retinal ganglion cell-inner plexiform layer complex in male diabetes

Purpose This study aims to evaluate the influence of smoking on ganglion cell-inner plexiform layer complex (GC-IPL) thickness and central macular thickness (CMT) measured by spectral domain optical coherence tomography (OCT) in male diabetes. Methods 90 smoking and 90 never-smoking male subjects were included in this study. They were divided into six groups based on the diagnostic criteria for diabetes and the Early Treatment Diabetic Retinopathy Study (ETDRS) classification: smoking healthy subjects (SH, n = 20), non-smoking healthy subjects (NSH, n = 20), smoking diabetic patients without diabetic retinopathy (SNDR, n = 40), non-smoking diabetic patients without diabetic retinopathy (NSNDR, n = 40), smoking diabetic patients with diabetic retinopathy (SDR, n = 30), and non-smoking diabetic patients with diabetic retinopathy (NSDR, n = 30). After a full ophthalmologic examination, GC-IPL thickness and central macular thickness (CMT) were measured by OCT. Statistical analysis was performed to compare GC-IPL thickness and CMT between groups. Multiple linear regression equations were constructed to explore the potential risk factors of mean GC-IPL thickness. Results There were no significant differences in GC-IPL thickness and CMT between SH and NSH (all p > 0.05). Mean, superonasal, superior, superotemporal, inferonasal, inferior GC-IPL (p＜0.001, p＜0.001, p＜0.001, p = 0.003, p = 0.001, and p = 0.005, respectively) were thinner in the SNDR than NSNDR except for inferotemporal GC-IPL thickness and CMT (p = 0.066, p = 0.605, respectively). Mean, superonasal, superior, and inferonasal GC-IPL were thinner in the SDR than NSDR (p = 0.019, p = 0.045, p = 0.037, and p = 0.049, respectively). Multiple regression analysis demonstrated that age (β [SE], −0.141 [0.060]; p = 0.020) and smoking (β [SE], −4.470 [1.015]; p＜0.001) were the most important determinants for mean GC-IPL thickness. Conclusion Smoking is associated with reduced retinal GC-IPL thickness in male diabetes. Smoking behavior and age are important determinants of mean GC-IPL thickness.

Optical coherence tomography changes in Egyptian patients with major depressive disorder

Background Brain imaging of patients with major depressive disorder (MDD) shows evidence of neurodegeneration and inflammation. The retina is believed to be a prolongation of the central nervous system, and therefore optical coherence tomography readings may give an insight into the pathogenesis of MDD. Patients and methods An observational controlled cross-sectional study was performed at Ain Shams University Hospitals from September 2018 to December 2019. Optical coherence tomography was used to compare a group of 30 patients with MDD with a control group of 28 healthy individuals. Measurements recorded were macular thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, and ganglion cell-inner plexiform layer complex (GC-IP) thickness. Results Patients with MDD demonstrated significant macular thinning in all zones of the ETDRS map except the central zone bilaterally, and the inner nasal and inner lower zones in right eye. The peripapillary RNFL thickness of patients with MDD revealed significant thinning in the superior quadrant of both eyes. The GC-IP complex of patients with MDD showed significant thinning in the whole temporal and inner lower nasal subzones of the right eye and the upper nasal and lower temporal subfields of the left eye. Conclusion Patients with MDD showed reduced thickness of the macula, RNFL, and GC-IP. This may indicate that MDD involves an element of neurodegeneration, such as evidenced in gray matter changes.

Macular ganglion cell-inner plexiform layer defect patterns in multiple sclerosis patients without optic neuritis: A Spectral-Domain-Optical Coherence Tomography Cross-Sectional, Case-Control, Pilot Study.

Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate, in patients with multiple sclerosis without a history of optic neuritis (MSNON), the proportion of the different macular ganglion cell-inner plexiform layer complex (mGCIP) defect patterns. The results were compared with those of healthy controls (HCs). In this cross-sectional case-control study, 34 eyes of 34 individuals, 17 with MSNON and 17 HCs, were evaluated. All participants underwent mGCIP thickness measurement using SD-OCT (Zeiss Cirrus HD-OCT 4000, macular cube protocol). The mGCIP defect patterns were classified in nine types (minimal, inner, outer, diffuse mild, diffuse severe inferior confined, inferior dominant, superior confined, and superior dominant), according to the shape derived by the deviation map of the instrument, and the proportion of each type was assessed. A mGCIP defect pattern was detected in 70.5% of MSNON eyes, with an inner type as the most frequent pattern (47%), followed by the outer type (11.7%) and the inferior confined type (11.7%). No defect was found in Hcs. A significant thinning of the mGCIP with the frequent presence of an inner defect was seen in MSNON patients. The presence of this defect may serve as a biomarker of subclinical optic nerve involvement in MS patients.

Asociación entre los parámetros vasculares y estructurales medidos mediante Angio-OCT en el glaucoma congénito

Objective: To determine the association of structural and vascular parameters using optical coherence tomography (OCT) angiography (-A), in patients diagnosed with primary congenital glaucoma (PCG). Material and methods: 40 patients diagnosed with PCG were recruited (only one eye per patient was included). All study participants underwent a comprehensive ophthalmologic examination. Peripapillary and macular vascular measurements were obtained using AngioplexTM OCTA with a 4.5×4.5mm optic nerve head scan and 6x6mm macular scan. Structural parameters were collected: circumpapillary Retinal nerve fiber layer (cpRNFL) thickness (global and quadrants), ganglion cell-inner plexiform layer complex (GCL+IPL) thickness (average, minimum and sectors), rim area, average and vertical cup to disc (C/D) ratio and cup volume. Results: Global peripapillary values were: Mean flux index (FI) was 0.39 (0.05), mean perfusion density (pPD) was 42.57 (4.56) %, cpRNFL was 78.65 (22.50) microns, average c/p ratio (0.59 (0.18) and global GCL+IPL thickness was 71.71 (14.81) microns and minimum GCL+IPL thickness was 64.18 (18.63) microns. Statistical correlation was found between peripapillary structural, vascular and morphologic parameters (all p&lt;0.023). Conclusion: OCTA measurements could offer useful and objective measurement of damage in early and severe congenital glaucoma, complementary to that offered by OCT.

Optical coherence tomography biomarkers for visual acuity in patients with idiopathic epiretinal membrane.

To investigate the correlation between outer and inner retina optical coherence tomography (OCT) biomarkers and visual acuity in patients with idiopathic epiretinal membrane (iERM) and identify which of them may be predictive of visual function. A retrospective cross-sectional single-center study was conducted that included patients diagnosed with iERM. Spectral domain OCT images were obtained and assessed qualitatively and quantitatively. The association of OCT parameters with best corrected visual acuity was analyzed. Charts of 97 eyes of 97 patients were reviewed. Central foveal thickness, maximal retinal thickness (MRT), photoreceptor outer segment length, outer foveal thickness, ganglion cell-inner plexiform layer complex thickening, inner retinal thickness and inner retinal layer irregularity index were among the major outcome measures. OCT scans were also assessed for the presence of cotton ball sign, ellipsoid zone disruption, ectopic inner foveal layer, disorganization of retinal inner layers (DRIL), intraretinal fluid, subretinal fluid (SRF) and epimacular membrane rip. Univariate analysis showed statistically significant association between all the aforementioned parameters with worse vision, except for cotton ball sign and SRF. Multivariate analysis found that MRT and severe DRIL were strongly correlated with worse vision (p < 0.001). MRT and severe DRIL should be considered as negative prognostic factors for visual acuity.

Retinal asymmetry in multiple sclerosis

Abstract The diagnosis of multiple sclerosis is based on a combination of clinical and paraclinical tests. The potential contribution of retinal optical coherence tomography (OCT) has been recognized. We tested the feasibility of OCT measures of retinal asymmetry as a diagnostic test for multiple sclerosis at the community level. In this community-based study of 72 120 subjects, we examined the diagnostic potential of the inter-eye difference of inner retinal OCT data for multiple sclerosis using the UK Biobank data collected at 22 sites between 2007 and 2010. OCT reporting and quality control guidelines were followed. The inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD) were calculated for the macular retinal nerve fibre layer (RNFL), ganglion cell inner plexiform layer (GCIPL) complex and ganglion cell complex. Area under the receiver operating characteristic curve (AUROC) comparisons were followed by univariate and multivariable comparisons accounting for a large range of diseases and co-morbidities. Cut-off levels were optimized by ROC and the Youden index. The prevalence of multiple sclerosis was 0.0023 [95% confidence interval (CI) 0.00229–0.00231]. Overall the discriminatory power of diagnosing multiple sclerosis with the IEPD AUROC curve (0.71, 95% CI 0.67–0.76) and IEAD (0.71, 95% CI 0.67–0.75) for the macular GCIPL complex were significantly higher if compared to the macular ganglion cell complex IEPD AUROC curve (0.64, 95% CI 0.59–0.69, P = 0.0017); IEAD AUROC curve (0.63, 95% CI 0.58–0.68, P &amp;lt; 0.0001) and macular RNFL IEPD AUROC curve (0.59, 95% CI 0.54–0.63, P &amp;lt; 0.0001); IEAD AUROC curve (0.55, 95% CI 0.50–0.59, P &amp;lt; 0.0001). Screening sensitivity levels for the macular GCIPL complex IEPD (4% cut-off) were 51.7% and for the IEAD (4 μm cut-off) 43.5%. Specificity levels were 82.8% and 86.8%, respectively. The number of co-morbidities was important. There was a stepwise decrease of the AUROC curve from 0.72 in control subjects to 0.66 in more than nine co-morbidities or presence of neuromyelitis optica spectrum disease. In the multivariable analyses greater age, diabetes mellitus, other eye disease and a non-white ethnic background were relevant confounders. For most interactions, the effect sizes were large (partial ω2 &amp;gt; 0.14) with narrow confidence intervals. In conclusion, the OCT macular GCIPL complex IEPD and IEAD may be considered as supportive measurements for multiple sclerosis diagnostic criteria in a young patient without relevant co-morbidity. The metric does not allow separation of multiple sclerosis from neuromyelitis optica. Retinal OCT imaging is accurate, rapid, non-invasive, widely available and may therefore help to reduce need for invasive and more costly procedures. To be viable, higher sensitivity and specificity levels are needed.

Combination of optical coherence tomography (OCT) and OCT angiography increases diagnostic efficacy of Parkinson's disease.

To assess the diagnostic efficacy of optical coherence tomography (OCT) and OCT angiography (OCTA) in Parkinson's disease (PD). OCT was used to obtain macular parameters and peripapillary retinal nerve fiber layer (RNFL) thickness. The macular superficial retinal vessel and foveal avascular zone (FAZ) were quantified with OCTA. The area under the receiver operating characteristic curve (AUC) indicated the diagnostic efficacy of the parameters. Thirty-five eyes from 35 PD patients and 35 eyes from 35 age-matched healthy subjects who served as controls were evaluated. The mean RNFL thickness overall and the thicknesses of the other three quadrants were similar in PD patients compared with controls (P≥0.358). The RNFL thickness at the temporal quadrant, total macular volume (TMV), macular retinal thickness (MRT), and ganglion cell-inner plexiform layer complex (GCL-IPL) thickness were reduced in the eyes of PD patients (P≤0.046). There was no difference between the CMT of PD patients compared with control subjects (P=0.163). The vessel length density (VLD) in the central, inner and full regions; vessel perfusion density (VPD) in all regions; and the FAZ circularity index in PD patients were significantly lower than in controls (P≤0.049). The AUC of the VLD in PD in the central, inner and full regions were 0.712, 0.728, and 0.650, respectively; The VPD in the central, inner and full region were 0.711, 0.756, and 0.682, respectively. The mean RNFL thickness in the temporal quadrant, TMV and MRT revealed an AUC of 0.718, 0.693 and 0.699, respectively. The VPD in the outer region, FAZ circularity and GCL-IPL thickness did not have diagnostic ability in distinguishing PD from normal eyes (P≥0.05). The AUCs of a combination of the VLD in the inner region and TMV, the VLD in the inner region and MRT, the VPD in the inner region and TMV, and the VPD in the inner region and MRT, were 0.843, 0.849, 0.849, and 0.848, respectively (P≤0.001). Decreased OCT and OCTA parameters were detected in the eyes of PD patients. Combined non-invasive measurements of OCT and OCTA had better diagnostic ability than either alone, and may provide an additional biomarker for PD progression.

Parafoveal thinning of inner retina is associated with visual dysfunction in Lewy body diseases.

BackgroundRetinal optical coherence tomography findings in Lewy body diseases and their implications for visual outcomes remain controversial. We investigated whether region‐specific thickness analysis of retinal layers could improve the detection of macular atrophy and unravel its association with visual disability in Parkinson's disease.MethodsPatients with idiopathic Parkinson's disease (n = 63), dementia with Lewy bodies (n = 8), and E46K mutation carriers in the α‐synuclein gene (E46K‐SNCA) (n = 4) and 34 controls underwent Spectralis optical coherence tomography macular scans and a comprehensive battery of visual function and cognition tests. We computed mean retinal layer thicknesses of both eyes within 1‐, 2‐, 3‐, and 6‐mm diameter macular discs and in concentric parafoveal (1‐ to 2‐mm, 2‐ to 3‐mm, 1‐ to 3‐mm) and perifoveal (3‐ to 6‐mm) rings. Group differences in imaging parameters and their relationship with visual outcomes were analyzed. A multivariate logistic model was developed to predict visual impairment from optical coherence tomography measurements in Parkinson's disease, and cutoff values were determined with receiver operating characteristic analysis.ResultsWhen compared with controls, patients with dementia with Lewy bodies had significant thinning of the ganglion cell–inner plexiform layer complex within the central 3‐mm disc mainly because of differences in 1‐ to 3‐mm parafoveal thickness. This parameter was strongly correlated in patients, but not in controls, with low contrast visual acuity and visual cognition outcomes (P < .05, False Discovery Rate), achieving 88% of accuracy in predicting visual impairment in Parkinson's disease.ConclusionOur findings support that parafoveal thinning of ganglion cell–inner plexiform complex is a sensitive and clinically relevant imaging biomarker for Lewy body diseases, specifically for Parkinson's disease. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The Evaluation of Ophthalmic Findings in Women Patients With Iron and Vitamin B12 Deficiency Anemia.

PurposeTo determine whether there are differences in the central corneal thickness (CCT), retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) in women with iron deficiency anemia (IDA) and vitamin B12 deficiency anemia (B12DA).MethodsThe patients were divided and evaluated in three groups as IDA (group 1), combined IDA-B12DA (group 2), and healthy females (group 3). Each group constituted 35 subjects. CCT, endothelial cell density (CD), the coefficient of variation (CV), and hexagonality (HEX) values were evaluated. Superior, nasal, inferior, and temporal retinal nerve fiber analysis were done, and mean thickness of GC-IPL complex was also evaluated.ResultsCCT was found to be less (thin CCT) in group 2 as compared to group 1 and group 3 (P = 0.016 and P = 0.013, respectively). While CD measurements did not vary significantly between the groups, CV value was found to be lower in the control group as compared to that in the other groups (P = 0.001 and P = 0.002, respectively). HEX and the thicknesses of all RNFL and GC-IPL were lower in both the anemic groups as compared to the control group (P = 0.012 and P = 0.013, respectively); however, no significant difference was determined between the anemia groups.ConclusionsIt should be noted that anemia is a common clinical picture particularly seen in women, and there may be a tendency toward corneal and retinal disorders in these patients. The present study found that presence in the patients with IDA and with combined IDA-B12DA may have influenced endothelial functions; also the patients with anemia had significantly thinner CCT than healthy controls.Translational RelevanceOptical coherence tomography and specular microscopy measurements may provide important data for early diagnosis and treatment of both corneal and retinal diseases according to the type of anemia in anemic women.

Outer Retinal Dysfunction in the Absence of Structural Abnormalities in Multiple Sclerosis.

Recent evidence suggests structural changes distal to the inner retina in multiple sclerosis (MS) patients. The functional correlates of these proposed structural abnormalities remain unclear. We investigated outer retinal function and structure in MS patients, and quantified to what extent outer retinal structure influenced function in these patients. Outer retinal function was assessed using the full-field and multifocal electroretinogram (ERG/MF-ERG), whereas retinal structure was assessed using spectral-domain optical coherence tomography (OCT). Results were compared with preexisting normative data. The relationships between electrophysiology parameters and the OCT values corresponding to the proposed cellular origins of the ERG and MF-ERG were analyzed. Most electrophysiological responses were delayed in MS patients, independently of optic neuritis (ON). Inner retinal thickness and volumes were reduced, and inner nuclear layer volume marginally increased, in eyes with previous ON; all other OCT parameters were normal. OCT results correlated with ERG amplitudes, but not with ERG peak times or any MF-ERG parameters. We recorded outer retinal dysfunction without detectable abnormalities of the corresponding retinal layers in MS patients, not ascribable to retrograde degeneration following ON. The findings complement a growing body of literature reporting primary retinal abnormalities distal to the ganglion cell-inner plexiform layer complex in MS patients, with our data suggesting that this may be a more widespread phenomenon than previously thought. ERG may be of more utility in detecting retinal dysfunction in MS patients than MF-ERG. Analysis of peak times, rather than response amplitudes, is recommended.

The Effect of LASIK Procedure on Peripapillary Retinal Nerve Fiber Layer and Macular Ganglion Cell-Inner Plexiform Layer Thickness in Myopic Eyes.

Purpose To evaluate the effect of applied suction during microkeratome-assisted laser in situ keratomileusis (LASIK) procedure on peripapillary retinal nerve fiber layer (RNFL) thickness as well as macular ganglion cell-inner plexiform layer (GC-IPL) thickness. Methods 89 patients (124 eyes) with established myopia range from −3.0 to −8.0 diopters and no associated ocular diseases were included in this study. RNFL and GC-IPL thickness measurements were performed by spectral domain optical coherence tomography (SD OCT) one day before LASIK and at 1 and 6 months postoperatively. Results Mean RNFL thickness prior to LASIK was 93.86 ± 12.17 μm while the first month and the sixth month postoperatively were 94.01 ± 12.04 μm and 94.46 ± 12.27 μm, respectively. Comparing results, there is no significant difference between baseline, one month, and six months postoperatively for mean RNFL (p > 0.05). Mean GC-IPL thickness was 81.70 ± 7.47 μm preoperatively with no significant difference during the follow-up period (82.03 ± 7.69 μm versus 81.84 ± 7.64 μm; p > 0.05). Conclusion RNFL and GC-IPL complex thickness remained unaffected following LASIK intervention.

Evaluation of retinal ganglion cell-inner plexiform layer complex in healthy smokers.

To evaluate the effect of smoking on ganglion cell complex and inner plexiform layer (GC-IPL) thickness measured by spectral domain optical coherence tomography (OCT). The right eyes of 36 smoking (study group) and 36 never-smoking (control group) healthy subjects were included in this study. After full ophthalmologic examination, axial length measurement (AL), ganglion cell complex-inner plexiform layer (GC-IPL) thickness, retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) values were measured by OCT. Statistical analysis was performed to compare GC-IPL, RNFL thicknesses, and CMT values between groups. The mean age [mean±standard deviation (SD)] of 36 subjects in the study group was 26.2±6.0years, and the mean age of 36 subjects in control group was 25.7±4.1years. The mean ALs of the study group and the control group were 22.46±0.88 and 22.36±1.09mm, respectively (p=0.68). Mean GC-IPL thickness was 82.8±3µm in the study group and 84.3±3µm in the control group (p=0.08). The mean RNFL values of study and control groups were 95. 8±7.9 and 97. 3±7.8µm, respectively (p=0.39). The mean CMT values of study and control groups were 248.3±17.96 and 249.5±17.18µm, respectively (p=0.78). Smoking does not seem to have any effect on GC-IPL thickness, mean RNFL and CMT values. Further studies in larger groups are needed to reveal the effect of smoking on these parameters.

Causes and Prognosis of Visual Acuity Loss at the Time of Initial Presentation in Idiopathic Intracranial Hypertension.

To determine the etiology and prognosis of visual acuity loss in idiopathic intracranial hypertension (IIH) at presentation and to provide objective measures to predict visual outcome. A retrospective review of 660 patients with IIH (2009-2013) identified 31 patients (4.7%) with 48 eyes having best-corrected visual acuity (BCVA) of 20/25 or worse on initial presentation. Fundus photography, optical coherence tomography (OCT) of the optic disc and macula, and perimetry were used to determine the causes and prognosis of vision loss. Segmentation of the macula OCT was performed using the Iowa Reference Algorithm to determine the retinal ganglion cell-inner plexiform layer complex (GCL-IPL) thickness. Outer retinal changes alone caused decreased BCVA at initial presentation in 22 eyes (46%): subretinal fluid in 16, chorioretinal folds in 5, and peripapillary choroidal neovascularization in 1. The vision loss was reversible except for some eyes with chorioretinal folds. Optic neuropathy alone caused decreased BCVA in 10 eyes (21%) and coexisting outer retinal changes and optic neuropathy caused decreased BCVA in 16 eyes (33%). A GCL-IPL thickness less than or equal to 70 μm at initial presentation or progressive thinning of greater than or equal to 10 μm within 2 to 3 weeks compared with baseline correlated with poor visual outcome. Visual acuity loss in IIH can be caused by both outer retinal changes and optic neuropathy. Vision loss from outer retinal changes is mostly reversible. The outcome of patients with coexisting outer retinal changes and optic neuropathy or optic neuropathy alone depends on the degree of optic neuropathy, which can be predicted by the GCL-IPL thickness.

Effect of smoking on retina nerve fiber layer and ganglion cell-inner plexiform layer complex

Purpose: The aim of this study is to show the effects of smoking on retina layers, especially retina nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer complex (GCIPL).Materials and methods: Participants smoking for more than 10 years at least 1 pack of cigarettes a day and a control group, both including participants between ages of 20 and 50 years with no other systemic or ocular diseases were studied. After normality tests, an independent sample t test was used to analyze the differences in age, sex, spherical equivalent (SE), intraocular pressure (IOP), axial length (AL), GCIPL and RNFL values between the groups.Results: There were 44 participants in each group. There were 32 (62.5%) men and 12(37.5%) women in smokers and 36 (77.88%) men and 8 (22.22%) women in control group. Mean ages were 39.85 ± 8.41 and 38.66 ± 10.47 years, mean spherical equivalent (SE) values were −0.15 ± 0.4 and 0 ± 0.29 dioptries in smokers and control groups, respectively. The IOP, AXL, GCIPL and RNFL values were 17.58 ± 3.41 mmHg, 23.69 ± 0.56 mm, 84.3 ± 5.83 μm and 92.3 ± 3.51 μm in the smokers group and 18.5 ± 2.91 mmHg, 23.45 ± 0.72 mm, 86.11 ± 8.02 μm and 97.66 ± 8.23 μm in the control group. The inferior, superior, nasal and temporal values of RNFL quadrants were 123.18 ± 26.14, 117.05 ± 5.51, 64.95 ± 8.67 and 63.5 ± 6.88 μm in the smokers group and 130.81 ± 11.8, 123.55 ± 11.03, 72.44 ± 9.84 and 58.44 ± 7.48 μm in the control group. There were no significant difference of age, sex, SE, IOP, AXL and GCIPL values between the smokers and control groups (p > 0.05). The mean RNFL was significantly thinner in the smokers group compared to controls (p = 0.03, independent t test). Inferior and superior quadrants of RNFL decreased in smokers group (p = 0.01 and p = 0.03, respectively) but temporal and nasal quadrants did not seem to be changed (p = 0.96 and p = 0.07, respectively).Discussion: Smoking may affect RNFL thickness but not GCIPL.

Variations of Retinal Nerve Fiber Layer Thickness and Ganglion Cell–Inner Plexiform Layer Thickness According to the Torsion Direction of Optic Disc

Purpose.: To examine the relationship between the optic disc torsion and peripapillary retinal nerve fiber layer (RNFL) thickness through a comparison with the macular ganglion cell inner plexiform layer complex (GCIPL) thickness measured by Cirrus optical coherence tomography (OCT). Methods.: Ninety-four eyes of 94 subjects with optic disc torsion and 114 eyes of 114 subjects without optic disc torsion were enrolled prospectively. The participants underwent fundus photography and OCT imaging in peripapillary RNFL mode and macular GCIPL mode. The participants were divided into groups according to the presence or absence of optic disc torsion. The eyes with optic disc torsion were further divided into supranasal torsion and inferotemporal torsion groups according to the direction of optic disc torsion. The mean RNFL and GCIPL thicknesses for the quadrants and subsectors were compared. The superior and inferior peak locations of the RNFL were also measured according to the torsion direction. Results.: The temporal RNFL thickness was significantly thicker in inferotemporal torsion, whereas the GCIPL thickness at all segments was unaffected. The inferotemporal optic torsion had more temporally positioned superior peak locations of the RNFL than the nontorsion and supranasal-torted optic disc. Conclusions.: Thickening of the temporal RNFL with a temporal shift in the superior peak within the eyes with inferotemporal optic disc torsion can lead to interpretation errors. The ganglion cell analysis algorithm can assist in differentiating eyes with optic disc torsion.