Ganglion cell complex analysis in thalassemia major patients measured by optical coherence tomography

Year 2021, Volume: 1 Issue: 2, 63 - 68, 27.07.2021

Semra Koca

Abstract

To analyze the changes in ganglion cell complex (GCC), peripapillary retinal nerve fiber layer (RNFL) thickness and central macular thickness (CMT) on spectral domain optical coherence tomography (OCT) in patients with thalassemia major. Forty one eyes of 41 patients with thalassemia major and 41 eyes of 41 healthy subjects were included in this prospective and comparative study. Peripapillary RNFL thickness, CMT and macular GCC thickness were evaluated with OCT (Cirrus HD-OCT 5000Carl Zeiss Meditec, Inc, Dublin, CA, USA) in all patients and healthy controls. Additionally, disease duration, serum ferritin level, hemoglobin concentration, the dosage and duration of chelation therapy, count of transfusion, patient’s weight were analyzed in thalassemia major group. RNFL thickness values were lower in the thalassemia patients but the difference was not statistically significant (except superior quadrant) and there was no significant differences in the mean CMT measurements. GCC thickness was thinner in all areas ( average, superior, inferior, superior-temporal, inferior-temporal, superior-nasal, inferior-nasal) but only the thinning in the inferior-temporal was statistically significant. GCC and RNFL thickness changes occur earlier than CMT changes in β-thalassemia major patients. GCC thickness measurements can be used for follow-up in combination with other diagnostic methods.

Keywords

iron, thalassemia major, optical coherence tomography, ganglion cell complex, ratinal nerve fiber layer

References

• Provan D, Singer CR, Baglin T, Dokal I. Oxford handbook of clinical haematology. Oxford: Oxford University Press; 2009
• Liaska A, Petrou P, Georgakopoulos CD, Diamanti R. β-Thalassemia and ocular implications: a systematic review. BMC Ophthalmol. 2016;16:102. doi: 10.1186/s12886-016-0285-2.
• Taneja R, Malik P, Sharma M, Agarwal MC. Multiple transfused thalassemia major: ocular manifestations in a hospital-based population. Indian J Ophthalmol 2010;58(2):125-30. doi: 10.4103/0301-4738.60083.
• Taher A, Bashshur Z, Shamseddeen WA, Abdulnour RE, Aoun E, Koussa S. et al. Ocular findings among thalassemia patients. Am J Ophthalmol 2006;142:704-5. doi: 10.1016/j.ajo.2006.04.030.
• Bollig C, Schell LK, Rücker G, Allert R, Motschall E, Niemeyer CM et al. Deferasirox for managing iron overload in people with thalassaemia. Cochrane Database Syst Rev. 2017;15;8(8):CD007476. doi: 10.1002/14651858.CD007476.pub3.
• Kontoghiorghe CN, Kontoghiorghes GJ. Efficacy and safety ofiron-chelation therapy with deferoxamine, deferiprone, and deferasirox for the treatment of iron-loaded patients with non-transfusion-dependent thalassemia syndromes. Drug Des DevTher. 2016;10:465-481. doi: 10.2147/DDDT.S79458.
• Bhoiwala DL, Dunaief JL. Retinal abnormalities in β-thalassemia major. Surv Ophthalmol. 2016 Jan-Feb;61(1):33-50. doi: 10.1016/j.survophthal.2015.08.005.
• Jafari R, Heydarian S, Karami H, Shektaei MM, Dailami KN, Amiri AA. et al. Ocular abnormalities in multi-transfused beta-thalassemia patients. Indian J Ophthalmol. 2015 Sep;63(9):710-5. doi: 10.4103/0301-4738.170986.
• Bazvand F, Shams S, Borji Esfahani M, Koochakzadeh L, Monajemzadeh M, Ashtiani MT. et al. Total Antioxidant Status in Patients with Major β-Thalassemia. Iran J Pediatr. 2011 Jun;21(2):159-65.
• Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W. et al. Optical coherence tomography. Science. 1991;254:1178-1181. doi: 10.1126/science.1957169.
• Gartaganis S, Ismiridis K, Papageorgiou O, Beratis NG, Papanastasiou D. Ocular abnormalities in patients with beta thalassemia. Am J Ophthalmol. 1989 Dec 15;108(6):699-703. doi: 10.1016/0002-9394(89)90864-7.
• Halliwell B, Gutteridge JM. Oxygen toxicity, oxygen radicals, transition metals and disease. Biochem J. 1984 Apr 1;219(1):1-14. doi: 10.1042/bj2190001.
• Song D, Dunaief JL. Retinal Iron Homeostasis in Health and Disease. Front Aging Neurosci. 2013 Jun;28;5:24. doi: 10.3389/fnagi.2013.00024.
• Manafikhi H, Drummen G , Palmery M, Ilaria Peluso. Total Antioxidant Capacity in Beta-Thalassemia: A Systematic Review and Meta-Analysis of Case-Control Studies. Crit Rev Oncol Hematol. 2017 Feb;110:35-42. doi: 10.1016/j.critrevonc.2016.12.007.
• Lakhanpal V, Schocket S, Jiji R. Deferoxamine (Desferal)- induced toxic retinal pigmentary degeneration and presumed optic neuropathy. Ophthalmology 1984;91:443–451. doi: 10.1016/s0161-6420(84)34267-1.
• Haimovici R, D’Amico DJ, Gragoudas ES, Sokol S, Deferoxamine Retinopathy Study Group. The expanded clinical spectrum of deferoxamine retinopathy. Ophthalmology 2002; 109:164–171. doi: 10.1016/s0161-6420(01)00947-2.
• Dettoraki M, Kattamis A, Ladas I, Maragkos K, Koutsandrea C, Chatzistefanou K. et al. Electrophysiological assessment for early detection of retinal dysfunction in β-thalassemia major patients. Graefes Arch Clin Exp Ophthalmol. 2017 Jul;255(7):1349-1358. doi: 10.1007/s00417-017-3650-9.
• Sakamoto K, Suzuki T, Takahashi K, Koguchi T, Hirayama T, Mori A. et al. Iron-chelating agents attenuate NMDA-Induced neuronal injury via reduction of oxidative stress in the rat retina. Exp Eye Res. 2018 Jun;171:30-36. doi: 10.1016/j.exer.2018.03.008.
• Acer S, Balcı YI, Pekel G, Ongun TT, Polat A, Çetin EN. et al. Retinal nerve fiber layer thickness and retinal vessel calibers in children with thalassemia minor. SAGE Open Med. 2016: 4:1-5. doi: 10.1177/2050312116661683.
• Aksoy A, Aslan L, Aslankurt M, Eser O, Garipardic M, Okumus S. et al. Retinal fiber layer thickness in children with thalessemia major and iron deficiency anemia. Semin Ophthalmol. 2014 Jan;29(1):22-6. doi: 10.3109/08820538.2013.839811.
• Uzun F, Karaca EE, Yıldız Yerlikaya G, Fındık H, Akın M. Retinal nerve fiber layer thickness in children with β-thalassemia major. Saudi J Ophthalmol. 2017 Oct-Dec;31(4):224-228. doi: 10.1016/j.sjopt.2017.10.001.
• Ulusoy MO, Türk H, Kıvanç SA. Spectral domain optical coherence tomography findings in Turkish sickle-cell disease and beta thalassemia major patients. J Curr Ophthalmol. 2019 Feb 14;31(3):275-280. doi: 10.1016/j.joco.2019.01.012.