Optical coherence tomography in differential diagnosis of optic neuropathy of various genesis
DOI: 10.32364/2311-7729-2024-24-4-2
S.I. Zhukova1, D.Yu. Samsonov1, T.N. Yurieva1–3, T.V. Prozorova1
1Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
2Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation
3Irkutsk State Medical University, Irkutsk, Russian Federation
Background: although thinning of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) revealed by optical coherence tomography (OCT) are nonspecific data, they represent a key link in pathogenesis of optic neuropathy (ON) regardless of etiology.
Aim: to identify differences between OCT patterns of RNFL and GCC damages associated with ON of different genesis.
Patients and Methods: еxamination data of 58 patients with a suspected or preliminary diagnosed glaucoma who underwent an ophthalmic examination in a glaucoma department were retrospectively analyzed. According to the findings, 2 groups were formed. A Group 1 included 19 patients with an initial stage of primary open-angle glaucoma. 12 patients with altered RNFL and GCC, ineligible for glaucoma ON (GON), were enrolled in a non-glaucoma ON (non-GON) group. As a result of a detailed analysis of complaints, systemic and neurological status, chronic non-arteritic ischemic ON was diagnosed in 5 patients of the Group 2. In 7 patients, ON was associated with a history of optic neuritis with underlying multiple sclerosis (MS). Thus, we are faced with ONs associated with glaucoma, ischemia and MS. Considering a fundamentally different approach to treatment of these diseases and relevance of their differential diagnosis, a comparative analysis of ganglion cell axon topography was carried out in 3 groups in the light of the medical condition (1 — glaucoma-associated lesions, 2 — ischemia-associated lesions, 3 — MS-associated lesions).
Results: the most pronounced RNFL alterations were observed in lower and temporal quadrants (GON patients); upper and nasal quadrants (ischemia patients); and in a temporal quadrant (MS patients). Retinal GCC lesions associated with GON and ischemia were asymmetric (superior defects in glaucoma patients vs. inferior defects in ischemia ones). MS-associated macular lesions were symmetrical and outstripped the RNFL alterations.
Conclusion: different patterns of peripapillary RNFL and macular GCC damages are caused by pathogenesis of primary neuronal damage. These differences can be used as differential diagnostic criteria for GON and non-GON conditions in routine clinical practice.
Keywords: optical coherence tomography, peripapillary retinal nerve fiber layer, macular ganglion cell complex, glaucoma ischemic optic neuropathy, non-arterial ischemic opticopathy, retrobulbar neuritis, multiple sclerosis.
For citation: Zhukova S.I., Samsonov D.Yu., Yurieva T.N., Prozorova T.V. Optical coherence tomography in differential diagnosis of optic neuropathy of various genesis. Russian Journal of Clinical Ophthalmology. 2024;24(4):170–176 (in Russ.). DOI: 10.32364/2311-7729-2024-24-4-2
About the authors:
Svetlana I. Zhukova — C. Sc. (Med.), Head of the Diagnostic Department, Board-Certified Ophthalmologist, Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; ORCID iD 0000-0002-0227-7682
Dmitry Yu. Samsonov — C. Sc. (Med.), Head of the Scientific and Educational Department, Board-Certified Ophthalmologist, Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; ORCID iD 0000-0001-7971-4521
Tatyana N. Yurieva — Dr. Sc. (Med.), Professor, Deputy Director for Scientific Work, Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; Professor of the Department of Ophthalmology, Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education; 100, Yubileinyy subdistrict, Irkutsk, 664049, Russian Federation; Professor of the Department of Eye Diseases, Irkutsk State Medical University; 1, Krasnogo Vosstaniya str., Irkutsk, 664003, Russian Federation; ORCID iD 0000-0003-0547-7521
Tatyana V. Prozorova — ophthalmologist, Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution; 337, Lermontov str., Irkutsk, 664033, Russian Federation; ORCID iD 0009-0000-5286-5784
Contact information: Svetlana I. Zhukova, e-mail: nauka@mntk.irkutsk.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 26.08.2024.
Revised 18.09.2024.
Accepted 11.10.2024.
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