Homonymous hemiatrophy of ganglion cell layer from retrochiasmal lesions in the visual pathway

Abstract

ObjectiveTo determine the temporal evolution, morphology, and frequency of macular ganglion cell atrophy in patients with retrochiasmal lesions of the visual pathway.MethodsIn a consecutive retrospective case series, we identified 47 patients with homonymous hemianopia and accessible macular optical coherence tomography scans. We estimated the time of lesion onset and the location of the lesion within the afferent visual pathway. Using semiautomatic layer segmentation, we determined ganglion cell layer thickness in areas projecting to the side of the retrochiasmal lesion and compared it with ganglion cell layer thickness on the healthy side.ResultsWe found that retrochiasmal lesions at any level may be associated with an atrophy of ganglion cells. This atrophy respects the vertical midline through the fovea and thus the anatomic separation of the nasal and temporal visual field. The vertical line separating the affected from the unaffected side has significantly less tilt as compared with the disc–fovea angle. Lesions of the optic tract are associated with earlier macular ganglion cell atrophy than retrogeniculate lesions. Macular ganglion cell atrophy may be present in cases with normal peripapillary nerve fiber layer analysis and vice versa.ConclusionsMacular ganglion cell layer thickness shows a topographic hemiatrophy in retrochiasmal lesions, which manifests earlier for tract lesions than for retrogeniculate lesions. This additional examination of ganglion cell homonymous hemiatrophy has a higher sensitivity in detecting retrograde transsynaptic degeneration than the analysis of the peripapillary nerve fiber layer alone.

Differences in morphology and visual function of myelin oligodendrocyte glycoprotein antibody and multiple sclerosis associated optic neuritis

“…Optical coherence tomography (OCT) is widely deployed in ophthalmology to quantify and monitor optic neuropathies, most frequently via the peripapillary nerve fiber layer (pRNFL). It has recently been shown that adding the macular ganglion cell layer (mGCL) thickness may have a better sensitivity than pRNFL alone in detecting optic neuropathies, and that the distribution of mGCL loss may provide additional localizing value of optic neuropathies [5,6].…”

Homonymous visual field defects in patients with multiple sclerosis: results of computerised perimetry and optical coherence tomography

“…6). Homonymous hemiatrophy of the ganglion cell layer was recently reported in a retrospective series of 47 patients with HVFD of various aetiologies [49]. The authors reported that such homonymous hemiatrophy could result from either direct retrograde axonal degeneration or transsynaptic retrograde axonal degeneration.…”

Homonymous visual field defect and retinal thinning after occipital stroke

“…The characteristic homonymous GCIPL thinning detected by OCT corresponds to ipsilateral occipital lesions and to contralateral homonymous quadrant‐ or hemianopia. This pattern of GCIPL thinning could be considered as direct evidence of retrograde degeneration and has been found in both congenital and acquired damages of the retrochiasmal pathway (Foster et al., 2019 ; Huang‐Link et al., 2014 ; Keller et al., 2014 ; Mühlemann et al., 2020 ; Yamashita et al., 2016 ). In our study, those with NVFD showed no homonymous GCIPL thinning and the average GCIPL thickness was relatively intact.…”