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R.K. Shetty, J.P. Bolling, M.W. Stewart; A Comparison of Retinal Arterial Occlusions and Severe Glaucoma with Optical Coherence Tomography . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3328.
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Purpose: To compare the optical coherence tomography of the retina in patients with a previous central or branch retinal artery occlusion and in patients with severe glaucoma. Methods: We analyzed a consecutive case series of 7 patients with a previous branch or central artery occlusion and 9 patients with severe glaucoma with Optical Coherence Tomography (OCT). Patients with artery occlusions that were more than 3 months from the embolic event were included. We studied 3 eyes with a branch retinal artery occlusion and 4 eyes with a central retinal artery occlusion. Glaucoma patients who have had an automated visual field within one year of their OCT scan and have an Advanced Glaucoma Intervention Study (AGIS) visual field test score of severe or end–stage were included. There were 4 eyes with severe glaucoma and 5 eyes with end–stage glaucoma. Patients with other retinal diseases including epiretinal membranes and exudative macular degeneration were excluded. The retinal anatomy, thickness, and volume of the central 6 mm of the macula were acquired by the macular thickness map protocol on the Zeiss StratusOCT model 3000. Results: Qualitatively, OCT scans of the macula in artery occlusions uniformly demonstrate a severe loss of inner retinal thickness and the conglomeration of the reflective nerve fiber and inner plexiform layers of the retina. In severe glaucoma, these distinctive layers of the retina are preserved with the nerve fiber layer appearing thinner than normal. Quantitatively, the thinnest retinal thickness measured on one of eight quadrants in the macula (other than the fovea) corresponded to a visual field deficit in each patient. The mean of the thinnest retinal thickness in eyes with an artery occlusion (131 ± 28 microns) is significantly different from that of eyes with severe glaucoma (186 ± 19 microns) (p < 0.0014). The range of the thinnest retinal thickness was 102 to 169 microns in artery occlusions and 162 to 217 microns in severe glaucoma. Macular volume in patients with arterial occlusions (4.9 ± 0.8 mm3) was also significantly different from those with severe glaucoma (5.8 ± 0.6 mm3) (p = 0.03). Conclusions: Retinal thickness and macular volume are both significantly different in arterial occlusions compared to severe glaucoma. Anatomical changes in the inner retina in arterial occlusions and in severe glaucoma can be differentiated on OCT.
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