June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
The relationship between retinal ganglion cell degeneration and retinal perfusion after acute traumatic brain injury
Author Affiliations & Notes
  • Elinor Laws
    NIHR Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
    Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Jenny Hepschke
    Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Noor Haziq Saliman
    NIHR Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
    Neuro-ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Antonio Belli
    Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, United Kingdom
    Birmingham Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Richard J Blanch
    NIHR Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
    Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, Birmingham, United Kingdom
  • Footnotes
    Commercial Relationships   Elinor Laws None; Jenny Hepschke None; Noor Haziq Saliman None; Antonio Belli None; Richard Blanch None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4303. doi:
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      Elinor Laws, Jenny Hepschke, Noor Haziq Saliman, Antonio Belli, Richard J Blanch; The relationship between retinal ganglion cell degeneration and retinal perfusion after acute traumatic brain injury. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4303.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Retinal blood flow, measured by optical coherence tomography angiography (OCTA) may be reduced by systemic disease and local ocular ischaemia, but also in association with retinal neurodegeneration. Traumatic brain injury (TBI) impairs the structure and function of the visual pathway. Retinal ganglion cell (RGC) layer degeneration and retinal perfusion loss can occur after TBI, even in absence of visual symptoms, with neurodegeneration delayed by several weeks. It is not clear whether reductions in retinal blood flow associated with neurodegeneration are caused by changes in retinal function (occurring at the time of injury) or simply reflect retinal structural changes (occurring only after neurodegeneration).

Methods : Retrospective case series. Patients attending for moderate to severe TBI assessment at a tertiary referral centre were included. Clinical examination, OCT, OCTA and Humphrey visual field (HVF) analysis were performed for each patient acutely and at follow-up. Data were extracted using manufacturer’s software with blood flow assessed as skeletonized vascular density, large vessel masked flow probability and vessel enhanced perfusion density and compared to corresponding retinal ganglion cell layer (GCL) thicknesses.

Results : Sixteen patients aged 20-65 years were included, 12 males and four females. Patients were examined within nine days of TBI and then after 2-6 months. GCL thinning preceded superficial vascular plexus perfusion loss. The strongest association was GCL thickness and skeletonized vascular density (adjusted R squared 0.86; p<0.0001). The degree of GCL thinning and perfusion loss correlated to baseline visual function on HVF.

Conclusions : Reduced retinal perfusion is association traumatic RGC degeneration, mirroring, rather than preceding, structural changes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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