Korean J Ophthalmol.  2014 Aug;28(4):314-322.

Assessment of Macular Ganglion Cell Loss Patterns in Neurologic Lesions That Mimic Glaucoma

• Shon K
• Sung KR

Abstract

PURPOSE
To evaluate patterns of macular retinal ganglion cell (RGC) loss measured by spectral domain optical coherence tomography in patients with neurologic lesions mimicking glaucoma.
METHODS
We evaluated four patients with neurological lesions who showed characteristic patterns of RGC loss, as determined by ganglion cell thickness (GCT) mapping.
RESULTS
Case 1 was a 30-year-old man who had been treated with glaucoma medication. A left homonymous vertical pattern of RGC loss was observed in his GCT map and a past brain magnetic resonance imaging (MRI) revealed a hemorrhagic lesion around the right optic radiation. Case 2 was a 72-year-old man with a pituitary adenoma who had a binasal vertical pattern of RGC loss that corresponded with bitemporal hemianopsia. Case 3 was a 77-year-old man treated for suspected glaucoma. His GCT map showed a right inferior quadratic pattern of loss, indicating a right superior homonymous quadranopsia in his visual field (VF). His brain MRI revealed a left posterior cerebral artery territory infarct. Case 4 was a 38-year-old woman with an unreliable VF who was referred for suspected glaucoma. Her GCT map revealed a left homonymous vertical pattern of RGC loss, which may have been related to a previous head trauma.
CONCLUSIONS
Evaluation of the patterns of macular RGC loss may be helpful in the differential diagnosis of RGC-related diseases, including glaucoma and neurologic lesions. When a patient's VF is unavailable, this method may be an effective tool for diagnosing and monitoring transneuronal retrograde degeneration-related structural changes.

Keyword

Ganglion cell thickness map; Neurologic region; Optical coherence tomography; Visual fields

MeSH Terms

Adult
Aged
Brain Injuries/diagnosis
Cerebral Infarction/diagnosis
Diagnosis, Differential
Female
Glaucoma/*diagnosis
Hemianopsia/diagnosis
Humans
Magnetic Resonance Imaging
Male
Nerve Fibers/*pathology
Nervous System Diseases/*diagnosis
Pituitary Neoplasms/diagnosis
Retinal Ganglion Cells/*pathology
Retrospective Studies
Tomography, Optical Coherence
Tonometry, Ocular
Visual Acuity
Visual Field Tests
Visual Fields

Figure

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  Fig. 1 Peripapillary retinal nerve fiber layer (RNFL) thickness (A) and ganglion cell thickness (GCT) (B) deviation maps with reference to a normative database were provided by spectral domain optical coherence tomography. GCT was defined as the layer from the outer boundary of the RNFL to the outer boundary of the inner plexiform layer. Each pixel in the deviation was coded in yellow or red for either the GCT or RNFL thickness deviation map if the measurement was below the lower 95% ("borderline") or above the 99% ("outside normal limits") centile range for that particular pixel. The GCT map shown here (B) has the typical arcuate shape defect observed in glaucoma. OD = right eye; OS = left eye; TEMP = temporal; SUP = superior; NAS = nasal; INF = inferior; GCL = ganglion cell layer; IPL = inner plexiform layer.

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  Fig. 2 The optic disc of a 30-year-old male showed increased cupping (A) and a spectral domain optical coherence tomography peripapillary retinal nerve fiber layer (RNFL) thickness map revealed thinning in both eyes (B). Analysis of the patient's visual field revealed a mild left homonymous hemianopsia (C). His macular Ganglion cell thickness map showed left homonymous vertical pattern of loss (D). His brain magnetic resonance imaging showed a hemorrhagic lesion around the right optic radiation (E). OD = right eye; OS = left eye.

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  Fig. 3 A brain magnetic resonance imaging of a 72-year-old man revealed a pituitary adenoma (A) displacing the pituitary stalk (arrow) and parenchyma to right side, and compression of the optic chiasm (arrowheads) on a T1-weighted gadolinium-enhanced image of the coronal section. (B) His left optic nerve looked more compressed than the right (arrows) on a T2-weighted coronal image (C). Analysis of his visual field revealed bitemporal hemianopsia (D) and a Ganglion cell thickness map showed a binasal vertical pattern of loss in the right eye, whereas the left eye showed a more generalized pattern of retinal ganglion cell loss, which was more severe at the nasal half and had a relatively preserved inferotemporal sector (E). OD = right eye; OS = left eye; GCL = ganglion cell layer; IPL = inner plexiform layer.

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  Fig. 4 Analysis of a 77-year-old man showed increased cupping in his optic disc (A) and optical coherence tomography peripapillary retinal nerve fiber layer (RNFL) thickness map is shown in (B). His Ganglion cell thickness map showed a right inferior quadratic pattern of loss (C) and analysis of his visual field showed a right superior homonymous quadranopsia (D). A brain magnetic resonance imaging revealed a left posterior cerebral artery territory infarct (E). OD = right eye; OS = left eye; GCL = ganglion cell layer; IPL = inner plexiform layer.

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  Fig. 5 Analysis of a 38-year-old woman showed mild cupping in her optic disc (A) and optical coherence tomography showed reduced retinal nerve fiber layer (RNFL) thickness (B). Her visual field result was unreliable (C) but a Ganglion cell thickness map revealed a left homonymous vertical pattern of loss (D). OD = right eye; OS = left eye; GCL = ganglion cell layer; IPL = inner plexiform layer.

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