The Macula in pediatric glaucoma: quantifying the inner and outer layers via optical coherence tomography automatic segmentation
Evan Silverstein, Sharon Freedman, Gérard-Philippe Zéhil, Kim Jiramongkolchai and Mays El-Dairi
Background: Recent Spectralis (Heidelberg, Germany) spectral domain optical coherence tomography (SD-OCT) research software can automatically quantify the thickness of each individual retinal layer. The macular ganglion cell layer (GCL) and ganglion cell complex may be more sensitive for detecting glaucoma than the peripapillary retinal nerve fiber layer (pRNFL). The aim of this study was to characterize and compare the volume of each macular layer in the eyes of children with glaucoma versus those of normal controls.
Methods: The medical records of children with primary glaucoma and physiologic cupping who had undergone Spectralis SD-OCT imaging of the macula and pRNFL were reviewed retrospectively. Controls were recruited from a separate prospective study. Children with refractive error of < ±5 or retinal or neurologic abnormalities were excluded. The average volume of each of the 6 retinal layers in the macula (central 6 mm) and pRNFL were compared among diagnostic groups.
Results: A total of 80 eyes of 80 children were included: 37 glaucoma eyes (25 with primary congenital and 12 with juvenile open-angle glaucoma) and 43 nonglaucoma eyes (28 with physiologic cupping). Eyes with glaucoma had significantly thinner mean macular nerve fiber layers, ganglion cell layers, inner plexiform layers, and pRNFLs than nonglaucomatous eyes: 0.82 ± 0.24 μm versus 1.00 ± 0.12 μm; 0.93 ± 0.22 μm versus 1.13 ± 0.10 μm; 0.80 ± 0.14 μm versus 0.91 ± 0.07 μm; 81.6 ± 26.5 μm versus 102.7 ± 10.0 μm, respectively (P < 0.00556 for all). Eyes without cupping and those with physiologic cupping were equivalent for all variables tested.
Conclusions: Children with glaucoma have thinning of the three innermost retinal macular layers.