Atlas of Ophthalmology

Focal Loss of Retinal Nerve Fiber Layer in Early Glaucoma (Colour Photography Posterior Pole)

Focal Loss of Retinal Nerve Fiber Layer in Early Glaucoma (Colour Photography Posterior Pole)
Colour Photography Posterior Pole: focal retinal nerve fiber layer loss with optic disc hemorrhage at 7h. Patient: 53 years of age, male, BCVA 1.0/1.0, IOP 13/14 mmHg, Pachymetry 559µm/579µm, optic disk size 2.0mm²/ 2.25mm². Ocular Medical History: optic disc hemorrhage at 7h , intraocular pressure 16-20mmH at OD, 11-18 mmHg at OS. General Medical History: increased body mass index. Purpose: evaluating ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL) thickness to present regional coincidence of focal retinal nerve layer fiber loss and retinal ganglion cell loss. Methods: Colour Photography Posterior Pole, Red Free Photography Posterior Pole, SD-OCT, Visual Field. Findings: Colour Photography Posterior Pole: focal retinal nerve fiber layer loss with optic disc hemorrhage at 7h. Red Free Photography Posterior Pole: focal retinal nerve fiber layer loss at 7h. SD-OCT, Retinal Nerve Layer Thickness: local thinning at 7h of the circumpapillary retinal nerve fiber layer (cpRNFL) around the optic disc. SD-OCT, macular retinal ganglion cells: focal macular retinal ganglion cells loss at 7h, corresponding to focal retinal nerve fiber layer loss. Visual Field: visual field defect at 11-2h, corresponding to focal retinal nerve layer loss at 7h. Mosaic, Colour Photography Posterior Pole, Red Free Photography Posterior Pole, SD-OCT: focal retinal nerve layer loss with optic disc hemorrhage at 7h, focal macular retinal ganglion cells loss at 7h, corresponding to focal retinal nerve fiber layer loss. Discussion: Glaucoma is an optic neuropathy characterized by retinal ganglion cells (RGC) loss and retinal nerve fiber layer (RNFL) injury. Medeiros FA et al. (1) showed, that glaucomatous eyes had an average retinal ganglion cells loss of 28%, ranging from 6% to 57%, at the time of the earliest visual field defect on standard automated perimetry (SAP) visual fields. Glaucomatous eyes with the earliest detectable visual field loss on automated perimetry may already show substantial loss of retinal ganglion cells. Literature: (1) Medeiros FA, Lisboa R, Weinreb RN, Liebmann JM, Girkin C, Zangwill LM. Retinal ganglion cell count estimates associated with early development of visual field defects in glaucoma. Ophthalmology. 2013 Apr;120(4):736-44.
Düz, Melek, Dr.med., Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Erlangen, Deutschland; Michelson, Georg, Prof. Dr. med., Interdisziplinäres Zentrum für augenheilkundliche Präventivmedizin und Imaging, Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
H40.1
Glaucomas, Ocular Hypertension -> Primary Chronic Open-Angle Glaucoma (POAG) -> Focal Loss of Retinal Ganglion Cells in Early Glaucoma (Colour Photography Posterior Pole, SD-OCT, VF)
10631
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