Progressive Loss of Myelinated Retinal Nerve Fibers in a Case of Open-Angle Glaucoma

Myelinated retinal nerve fibers (MRNFs) result from a developmental anomaly in which ectopic oligodendrocytes myelinate retinal ganglion cell fibers. These fibers typically remain stable over time in the absence of pathology. We identified unilateral MRNFs in a patient during an ophthalmological examination associated with ocular hypertension. Over an 8-year follow-up period, we observed a progressive decrease in the retinal nerve fiber layer and a rarefaction of MRNFs, which we attributed to the lack of regular follow-up and treatment compliance. The absence of neuropathy control in this patient makes this description close to the natural evolution of the disease. Similar progressive disappearance of MRNFs has been observed in cases of Behçet's disease, pituitary adenoma, and open-angle glaucoma. In patients with known MRNFs, their disappearance should alert clinicians to potential optic nerve damage and prompt further examinations to determine the underlying cause.