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Jakaria Mostafa, Suzanne Wickum, Laura J Frishman, Jason Porter; Retinal abnormalities in patients with different severities of traumatic brain injury. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5647. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Recent studies report varying degrees of structural and functional abnormalities in the inner retina of traumatic brain injury (TBI) patients. The extent to which such abnormalities are related to the severity of injury is less well known. We sought to quantify inner retinal abnormalities in mild versus severe civilian TBI patients and their relation to functional abnormalities of the central visual pathway.
Volume scans of the macula and optic nerve head were acquired with spectral domain optical coherence tomography in both eyes of 12 patients with mild TBI and 19 patients with severe TBI, 10 of 19 were with homonymous hemianopia (HH) (time post-injury: 0.25–9.4 years). Severity was assessed using the Glasgow Coma Scale or a characterization of neuroimaging results. Peripapillary retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell-inner plexiform layer thickness (GCIPLT) were quantified globally and in sectors, and compared with instrument-based normative data. Photopic negative response (PhNR) amplitudes were measured in 20 of these patients using the full-field flash electroretinogram and compared to normative data. Mean deviation (MD) was quantified via 30-2 standard automated perimetry.
Global or sectoral GCIPLT and RNFLT, MD and PhNR amplitude were abnormal in 50%, 47%, 65% and 65% of all eyes, respectively. Global GCIPL was thinner in a greater percentage of severe versus mild TBI patients (68% vs. 0%, P<.05; χ2 test). Within the severe TBI group, eyes with HH had thinner global GCIPLs more frequently than in non-HH patients (73% vs. 55%, P<.05; χ2 test). Within the mild TBI group, 5 of 8 patients had reduced PhNR amplitudes while none had global structural damage. A significant relationship between MD and global GCIPLT (P<.05; Spearman’s rank correlation) was found across all eyes (r=0.53) and within severe patients (r=0.6), suggesting that eyes with more extensive field loss tended to have greater thinning of inner retinal structures.
There was a higher prevalence of structural damage in the inner retina in severe TBI versus mild TBI patients. Severe TBI patients with HH had the highest frequency of structural damage among all groups. PhNR measurement may detect functional abnormalities in the inner retina in mild TBI patients without structural damage. Inner retinal measures may serve as objective biomarkers to better classify and diagnose TBI.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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