Retinal Ganglion Cell Loss Precedes Retinal Nerve Fiber Thinning in Nonarteritic Anterior Ischemic Optic Neuropathy

Background: Loss of retinal ganglion cell-inner plexiform layer (GCIPL) thickness has been shown in different optic neuropathies. In this study, we evaluated the capability of GCIPL analysis by optical coherence tomography (OCT) to detect early neuronal loss during the time course of non-arteritic anterior ischemic optic neuropathy (NAION). Methods: Twenty-four patients with unilateral NAION participated in this prospective, comparative study. Affected and unaffected eyes underwent spectral domain OCT measurement of the retinal nerve fiber layer (RNFL), total macula, and GCIPL thicknesses. These measurements were recorded in the acute phase (within 7 days) and at 1, 3, and 6 months. Results: At the initial presentation and 1, 3, and 6 months, the mean RNFL thickness in the NAION eyes was 236.5 mu m +/- 74.2, 157.1 mu m +/- 45.7, 61.4 mu m +/- 6.1, and 55.0 mu m +/- 19.5, respectively. Similar to RNFL, thinning of the mean total macular thickness in inner and outer rings started after 3 months and thicknesses decreased to 307.7 mu m +/- 15.3 and 273.1 mu m +/- 21.2 after 3 months and to 309.1 mu m +/- 15.0 and 273.4 mu m +/- 13.8 after 6 months, compared with unaffected contralateral eyes, respectively (all P < 0.0001). Thinning of the GCIPL was first evident in the affected NAION eyes at 1 month, and the mean inner and outer GCIPL thicknesses were 62.8 mu m +/- 14.6 and 53.9 mu m +/- 7.2 at 1 month in the NAION eyes compared with unaffected eyes (P < 0.001). After 3 and 6 months, the inner and outer GCIPL thicknesses were 51.1 mu m +/- 8.1 and 47.4 mu m +/- 5.31, and 50.6 mu m +/- 11.5 and 47.9 mu m +/- 5.6, respectively. Conclusions: Thinning of the GCIPL is first detectable at 1 month after NAION and persists for 3 months. GCIPL thinning occurs before RFNL thinning in NAION. (C) 2016 by North American Neuro-Ophthalmology Society