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Robert Zusman, Aaron Carass, Yufan He, Jerry Prince, Howard S Ying, Gislin Dagnelie, Alfred Vinnett, Ava K Bittner; Longitudinal Reductions in Thickness of Foveal Inner Retinal Layers in Relation to Progressive Vision Loss in Retinitis Pigmentosa Patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):50.
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Purpose: In previous cross-section studies of spectral-domain optical coherence (SD-OCT) in retinitis pigmentosa (RP) patients, the macular ganglion cell layer and inner plexiform layer (GCL+IPL) thickness was signficantly reduced in eyes with greater loss of photoreceptors, visual acuity (VA), and/or contrast sensitivity (CS). Inner retinal changes may represent distinct stages of retinal remodeling that occur before, during, or after photoreceptor loss, which we explored in a longitudinal case series.
Methods: Macular SD-OCT images were obtained with the Heidelberg Spectralis at 3-4 visits over a period of 26-56 months in six eyes of three RP patients with VA ranging 0.22-1.54 logMAR at baseline. Retinal layer thickness was calculated in the ETDRS central subfield for each of the segmented layers in the inner retinal: retinal nerve fiber layer (RNFL), GCL+IPL, and inner nuclear layer (INL). At the same visits when SD-OCT images were acquired, as well as before and/or after visual function was assesed with ETDRS VA, Pelli-Robson CS and Goldmann Visual Fields (GVF).
Results: In a 48 y/o male with x-linked RP due to an RPGR mutation, the eye with better visual function developed a 54% reduction in the INL over 2 years; during this time period and including a year prior, there was no VA loss, but he had a significant VA loss of 0.64 logMAR was documented 2 years later. In a 47 y/o male with presumed autosomal recessive RP, retinal thickness in one eye was reduced by 51% for the INL, 57% for the GCL+IPL, and 42% for the RNFL over one year, while the fellow eye had a 44% reducton in the INL; during this time period, there were no signficant VA losses (≤0.04 logMAR), but VA losses of 0.19 and 0.23 logMAR occurred in each eye two years later, at which time there was no further inner retinal thickness loss. In a 23 y/o male with RP of unknown inheritance/mutation, the eye with more severe CS loss developed a 52% and 44% reduction in the INL and RNFL, respectively, while the fellow eye had a 28% and 66% reduction in the GCL+IPL and RNFL over 3 years; during this time period, VA, CS, and GVF III4e declined by 0.22-0.24 logMAR, 0.50-0.70 logCS and 77-85% in each eye.
Conclusions: Loss of tissue in the inner retinal layers of the central macula preceded or occurred in conjunction with central visual function loss in patients with RP.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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