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P. Jindahra, A. Petrie, G. T. Plant; Demonstration of Trans-Synaptic Retrograde Loss of Retinal Ganglion Cell Loss Following Retrogeniculate Lesions in Humans Using Optical Coherence Tomography(OCT). Invest. Ophthalmol. Vis. Sci. 2009;50(13):5665.
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Trans-synaptic retrograde loss of retinal ganglion cells in humans is well established with congenital lesions but controversial with acquired pathology. The aim of the study was to investigate whether thinning of the retinal nerve fibre layer (RNFL) can be detected in such cases using OCT.
The thickness of the RNFL was measured in microns using Stratus OCT. There were three patient groups all with occipital damage: cases of acquired homonymous hemianopia (AHH; n=19); congenital homonymous hemianopia (CHH; n=7) and a mixed group of both congenital and acquired homonymous quadrantanopia (CAHQ). The results were compared with the right and the left eyes of 22 controls. A repeated measures analysis of variance was performed to compare the mean values in the different groups, separately for the eyes with temporal hemianopia (crossing fibre defect eyes, CFD) and for the eyes with nasal hemianopia (non-crossing fibre defect eyes, NonCFD).
The mean RNFL in the CFD eyes was 79.8µ (SD=35.1µ) in AHH, 72.7µ (33.2µ) in CHH, and 100.8µ (35.4µ) in the right eyes of the controls. The mean RNFL in nonCFD eyes was 83µ (29.5µ) in AHH, 73.4µ (26µ) in CHH, and 101.4µ (36.6µ) in the left eyes of the controls. In the CFD eyes, the mean RNFL was significantly greater in the control group than in either of the hemianopia groups (p<0.001). In the NonCFD eyes, there were significant differences between all three RNFL group means (p<0.001).For the CAHQ group the mean RNFL in the CFD eyes was 88.2µ (35.1µ) and in the NonCFD eyes was 89.2 µ (30.4µ). The mean RNFL was significantly greater in the controls than in the quadrantanopia group (p=0.003) in both eyes. The results were also analysed by dividing the peripapillary nerve fibre into 12 equal sectors around the circumference of the optic disc. These results demonstrated that the RNFL thinning corresponded to the known trajectories of the crossing and non-crossing fibres entering the optic disc and also to the retinal region of origin corresponding to the visual field loss.
We have shown that trans-synaptic retrograde degeneration of retinal ganglion cells occurs in both congenital and acquired post-geniculate lesions in humans and that the magnitude of the loss is similar in both.
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