Macular Ganglion Cell Analysis Determined by Cirrus HD Optical Coherence Tomography for Early Detecting Chiasmal Compression

Abstract

PurposeTo evaluate the performance of macular ganglion cell-inner plexiform layer (mGCIPL) measurement with Cirrus high-definition (HD) optical coherence tomography (OCT) for early detection of optic chiasmal compression.MethodsForty-six eyes of 46 patients with optic chiasmal compression caused by a pituitary adenoma (PA group), 31 eyes of 31 patients with normal tension glaucoma (NTG group), and 32 eyes of 32 normal participants (control group) were enrolled. The PA group was subdivided into two subgroups, which comprised patients with temporal visual field (VF) defects (perimetric PA group, 34 eyes) and without VF defect (preperimetric PA group, 12 eyes). The mGCIPL thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness were measured using Cirrus HD-OCT. We calculated the number of patients who had an abnormal GCA sector map, defined as at least one yellow or red sector.ResultsEyes in the perimetric PA group had significantly decreased mGCIPL thickness in all sectors. Eyes in the preperimetric PA group had significantly thinner mGCIPL in the superior, superonasal, inferonasal, and inferior sectors than eyes in control group, but no changes in cpRNFL parameters were observed. The mGCIPL thickness in inferonasal area showed the greatest AUC value (0.965), followed by the superonasal area (0.958) for discriminating preperimetric PA group from the control group. A higher reduction rate of mGCIPL thickness was noted in the nasal sector compared to other sectors, which was irrespective of temporal visual field defects. The mGCIPL thickness maps showed superonasal (P = 0.003) and inferonasal thinning in the PA group (P = 0.003), while inferotemporal thinning was revealed in the NTG group (P = 0.001).ConclusionsMacular GCIPL thickness parameters obtained with the Cirrus HD-OCT were useful in early detection of chiasmal compression and differentiating from NTG by characteristic nasal mGCIPL thinning.

Parafoveal and Peripapillary Perfusion Predict Visual Field Recovery in Chiasmal Compression due to Pituitary Tumors

“…In our study, the average preoperative pRNFL was 91 µm, which was thicker than the average in previous reports (range, 73-88 µm) [1,3,8,27,28]. The average preoperative MD on the perimetry was also −7.27 dB in our study, higher than in other studies (range, −9.62 to −17.5 dB) [1,3,6,7,29]. Therefore, this study may have included a higher number of cases with mild VF MD and fewer structural changes, which may have resulted in a lower statistical significance in the correlation analysis of pRNFL and GCC thickness.…”

Invited Commentary: Ganglion Cell Complex Measurement in Compressive Optic Neuropathy

“…Tieger et al report that in patients with chiasmal compression, the mean deviation assessed by 30° Humphrey perimetry correlates more strongly with the thickness of the GCC than with the RNFL. I leave arbitration of this point to OCT aficionados, but note that others have come to a similar conclusion (7). To me, the most striking finding is that data for both GCC and RNFL are quite noisy (Tieger et al, Fig.…”

The Use of Optical Coherence Tomography in Chiasmal Compression

“…Naopak pro glaukom je typická ztráta tloušťky RNFL v horním a dolním segmentu [7]. Další práce poukazují na opodstatněnost měření RNFL [24,27] nebo tloušťky vrstvy gangliových buněk (Ganglion Cell Layer, GCL) [2,16,19,29,30,34] v makulární oblasti. Existuje i práce, která vedle signifikantního snížení výše popsaných parametrů, nalezla i paralelní ztluštění vnitřní jádrové vrstvy (Inner Nuclear Layer, INL) [25].…”

“…Vysvětlením může být menší systematika "promítání viděného" do topiky nervových vláken než jak tomu je v případě buněk GCL. Bylo ale přítomné významné ztenčení RNFL v nazálním a temporálním sektoru (v porovnání s horním a dolním kvadrantem), jak je tomu v jiných publikacích věnujících se kompresivním lézím zrakové dráhy [19,34]. Protože se množily názory zpochybňující opodstatněnost měření RNFL, novější studie vyzdvihly roli GCL, resp.…”