Macular optical coherence tomography (OCT) analysis can be used for quantitative measures of optic nerve atrophy at a location far away from the optic nerve head. This has recently led to the discovery of microcystic macular oedema (MME), in the form of vacuolar inclusions within the macular inner nuclear layer, in patients with glaucoma. The level of the individual retinal layers’ involvement in glaucomatous optic neuropathy still remains unclear. The current study systematically investigated glaucoma-induced changes in various macular layers to evaluate whether glaucoma-associated damage extends beyond the macular ganglion cell layer. This cross-sectional observational study included 218 consecutive patients and 282 eyes with confirmed primary open-angle glaucoma or pseudoexfoliative glaucoma. Eyes were screened for presence of MME. Thickness of individual retinal layers was determined using a semi-automated segmentation algorithm (Spectralis HRA+OCT). Peripapillary nerve fibre layer thickness and mean defect in visual field testing were extracted from OCT and medical records, respectively. Results were compared with a small control group of eyes with no manifest glaucoma. The authors found MME in five eyes from five primary open-angle glaucoma patients and three eyes of three pseudoexfoliative glaucoma patients (2.8%). MME was confined to the inner nuclear layer in a perifoveal ring and was associated with thinning of the ganglion cell layer and thickening of the macular inner nuclear layer. Glaucoma eyes without MME showed a significant inverse correlation of inner nuclear layer thickness with glaucoma severity. The authors concluded that glaucomatous damage leads to a gradual thickening of the inner nuclear layer, which leads to MME in more severe glaucoma cases. These changes, alongside with nerve fibre loss and ganglion cell loss, may be summarised as glaucoma-associated retrograde maculopathy.

Retrograde maculopathy in patients with glaucoma.
Brazerol J, Iliev ME, Höhn R, et al.
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Chrysostomos D Dimitriou

Essex County Hospital, Colchester, Essex, UK.

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