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Y. Yucel, Q. Zhang, L. Ang, N. Gupta; Evidence for Neural Degeneration in Human Glaucoma Involving the Intracranial Optic Nerve, Lateral Geniculate Nucleus and Visual Cortex . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1181.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To evaluate changes in the intracranial optic nerve, lateral geniculate nucleus (LGN) and visual cortex in a human glaucoma brain compared to age–matched control human brains. Methods:Following institutional ethics board approval, 5 control post–mortem human brains and one post–mortem brain of a patient with primary open angle glaucoma were studied. The clinical history of the glaucoma patient included documented optic nerve damage and superior field defects. Examination of all brains by two neuropathologists revealed no primary neurodegenerative disease or cerebrovascular pathology. The prechiasmal optic nerves were cross–sectioned and immunostained for phosphorylated neurofilament and glial fibrillary acid protein to assess optic nerve fibers and glial elements, respectively. The entire postchiasmal right hemispheres including the LGN and the visual cortex were serially sectioned into 50 µm thick sections. Every 15th section was stained with Nissl allowing the visualization of the neuronal layers and cytoarchitecture. The volume of the right LGN was determined using the Cavalieri method. The LGN cross–sectional area for each section was determined using an unbiased point counting method. The total LGN cross–sectional area was multiplied with the interval between sections to compute the volume of the entire LGN in normal and glaucoma brains. Neuropathological comparisons between the medial and lateral half of the LGN and the superior and inferior banks of the primary visual cortex were performed for clinical–pathological correlation. Results:Marked atrophy and pathological dropout of nerve fibers was observed in the glaucomatous prechiasmal optic nerves compared to controls. The volumes of the right control LGNs ranged from 87.48 mm³ to 112.73 mm³ (mean ± SD, 99.31 ± 12.161 mm³). The glaucomatous right LGN volume was 69.32 mm³, less than the mean of the controls minus 2SD. In the primary visual cortex of the glaucoma brain, cytoarchitectural changes were observed. Conclusions:In human glaucoma, the central visual system undergoes degenerative changes at the level of the intracranial optic nerve, LGN and visual cortex. These findings are in keeping with previously observed CNS neural degeneration in experimental primate glaucoma.
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