Retinal nerve fiber layer analysis of cupping in children born prematurely
Lora R D Glass1, George A Cioffi, Dana M Blumberg
1Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY.
Insights
Premature infants with optic nerve cupping show reduced retinal nerve fiber layer (RNFL) thickness. This thinning suggests optic nerve hypoplasia rather than congenital glaucoma in these pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Neuroscience
Background:
- Optic nerve cupping in premature infants can be challenging to diagnose.
- Distinguishing between optic nerve hypoplasia and congenital glaucoma is crucial for appropriate management.
Purpose of the Study:
- To quantitatively assess retinal nerve fiber layer (RNFL) thickness in premature children with isolated optic nerve cupping.
- To compare RNFL thickness in this cohort with age-matched controls.
Main Methods:
- Observational case series of six premature children with increased cup to disc ratios.
- Retinal nerve fiber layer (RNFL) thickness measured using Cirrus optical coherence tomography (OCT).
- Comparison with normal controls using T-tests and Bonferroni correction.
Main Results:
- Statistically significant decrease in overall RNFL thickness observed.
- Significant thinning in the superior quadrant RNFL.
- Decreased RNFL thickness in inferior, nasal, and temporal quadrants, though not statistically significant.
Conclusions:
- RNFL thinning in premature children with enlarged cups is more indicative of optic nerve hypoplasia.
- Findings suggest optic nerve hypoplasia over congenital glaucoma due to markedly decreased RNFL thickness without other glaucoma signs.
Purpose:
The aim of this study was to quantitatively study the retinal nerve fiber layer (RNFL) thickness in children born prematurely with isolated optic nerve cupping.
Patients And Methods:
Six otherwise healthy premature children with clinical evidence of increased cup to disc ratios were enrolled in this observational case series. RNFL thickness was measured using Cirrus optical coherence tomography (OCT) optic disc cube 200×200 protocol and compared with age-matched normal controls using T test for statistical significance, with Bonferroni correction when appropriate.
Results:
Nerve fiber layer measurements showed a statistically significant decrease in overall RNFL. Superior quadrant RNFL thinning was statistically significant and inferior, nasal, and temporal nerve fiber layer thickness was decreased, although results were not statistically significant.
Conclusions:
Nerve fiber layer thinning in children born prematurely showing enlarged cup to disc ratios appears more consistent with optic nerve hypoplasia than glaucoma, as reflected by the markedly decreased average nerve fiber layer thickness with no other hallmarks of congenital glaucoma.
