Evaluation Of The Retinal Nerve Fiber Layer And Macular Thickness In Patients With Transient Monocular Blindness

Yıl 2015, Cilt: 12 Sayı: 2, 269 - 273, 30.08.2015

Tuğba Göncü , Halit Oğuz Ali Akal Sevim Çakmak Fatih Mehmet Adıbelli , Özcan Kocatürk

Öz

Background: Chronic cerebral hypoperfusion was observed in patients with transient ischemic attack. In
order to prevent a subsequent ischemic stroke, early diagnosis and proper management of transient ischemic
attack are essential. Transient monocular blindness (TMB) accounts for 25% of transient ischemic attacks.
Ischemic TMB occurs in the internal carotid territory and is a risk for ischemic stroke. Among patients with
TMB, 27-67% of them had carotid artery stenosis and associated with a risk of ischemic stroke. Optical
coherence tomography (OCT) which is widely used in ophthalmology is a noninvasive and easy technique
that allows imaging of the retinal nerve fiber layer thickness (RNFT) and macular volume.
In the present study, we aimed to evaluate the OCT findings of RNFT, central foveal thickness (CFT) and
macular volume of patients with TMB.
Methods: This is a prospective, comparative study of the 14 patients with TMB and 16 age and sex-matched
healthy subjects. After routine eye examination; RNFT, macular volume and CFT measurements were
performed by OCT.
Results: There was no significant difference between two groups in respect of age and sex (p=0,60 and
p=0,71 respectively). In our study group, the mean total RNFT was significantly higher in comparison to the
control (p=0,008). In respect to sectoral evaluation, RNFT did not differ significantly between the study and
3 the control group (p>0,05). The mean macular volume was 8,6±0,2 mm in the control group and it was
3 9,0±0,6 mm in the study group and this was significantly higher (p<0,001). Similarly, the CFT was
264,2±32,9 μm in the control group and it was 309,2±64,9 μm in the study group and this was significantly
higher (p<0,001).
Conclusion: In the present study, the total RNFT, macular volume and CFT were found to be higher in
patients with TMB compared to the controls. Further studies with larger sample size in which OCT findings
of patients with TMB are evaluated would be beneficial to obtain detailed information.

Anahtar Kelimeler

Transient Ischemic Attack, Transient Monocular Blindness (Amaurosis Fugax), Optical Coherence Tomography

Geçici Görme Kaybı Olgularında Optik Koherens Tomografi İle Retina Sinir Lifi Ve Makülanın Değerlendirilmesi

Öz

Amaç: Geçici iskemik atak olgularında kronik serebral hipoperfüzyonu saptanmıştır. Takip edebilecek
iskemik serebrovasküler hastalık gelişimini engellemek için geçici iskemik atağın erken tanısının konması
ve gerekli müdahalenin yapılması önemlidir. Geçici görme kaybı (GGK) geçici iskemik atakların %25'ini
oluşturmaktadır. İskemiye bağlı oluşan GGK de internal karotid arterin perfüzyon alanında olup serebral
iskemi için risk oluşturmaktadır. Geçici görme kaybı hastalarının %27-67'sinde zeminde karotis arter
hastalığı vardır ve iskemik serebrovasküler hastalık açısından önemli bir risk oluşturur. Optik koherens
tomografi (OKT), oftalmolojide yaygın olarak kullanılan retina sinir lifi kalınlığı (RSLK) ve maküler
hacmin ölçüldüğü noninvasif, kolay bir yöntemdir.
Çalışmamızda GGK tanısı alan olguların OKT ile RSLK, santral foveal kalınlık ve maküla hacminin
değerlendirimesi amaçlanmıştır.
Materyal ve Metod: Prospektif olarak yapılan bu çalışmaya 14 GGK hastası ve kontrol grubu olarak 16
sağlıklı birey dahil edilmiştir. Her iki gruba da rutin oftalmolojik muayeneyi takiben OKT kullanılarak
RSLK, maküla hacmi ve santral foveal kalınlık ölçümleri alınmıştır.
Bulgular: Yaş ve cinsiyet açısından iki grup arasında istatistiksel açıdan anlamlı bir farklılık yoktu (sırasıyla
p=0,60 ve p=0,71). Çalışma grubunda total RSLK, kontrol grubu ile karşılaştırıldığında anlamlı olarak daha
fazla olduğu görüldü (p=0,008). Fakat sektörlere göre RSLK değerlendirildiğinde hiç bir sektör için iki grup
3 arasında anlamlı fark olmadığı görüldü (p>0,05). Kontrol grubunun ortalama maküla hacmi 8,6±0,2 mm
3 iken çalışma grubunda bu değer 9,0±0,6 mm idi (p<0,001). Ortalama santral foveal kalınlık kontrol
grubunda 264,2±32,9 μm iken çalışma grubunda 309,2±64,9 μm idi (p<0,001).
Sonuç: Bu çalışmada GGK hastalarında total RSLK, total maküla hacminin ve santral foveal
kalınlığın anlamlı bir şekilde artmış olduğu izlenmiştir. Daha geniş hasta serilerinde GGK tanısı alan
olguların OKTverilerinin değerlendirilmesi daha detaylı bilgi sağlayacaktır.

Anahtar Kelimeler

Geçici İskemik Atak, Geçici Görme Kaybı (Amarozis Fugaks), Optik Koherens Tomografi

Kaynakça

• 1.Wong TY, Klein R, Couper DJ, Cooper LS, Shahar E, Hubbard LD, Wofford MR, Sharrett AR. Retinal microvascular abnormalities and incident stroke: the Atherosclerosis Risk in Communities Study. Lancet. 2001;358(9288):1134–1140. 2.Ikram MK, de Jong FJ, Bos MJ, Vingerling JR, Hofman A, Koudstaal PJ, de Jong PT, Breteler MM. Retinal vessel diameters and risk of stroke: the Rotterdam Study. Neurology. 2006;66(9):1339–1343. 3.Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2007;6(12):1063–72. 4.Rothwell PM, Giles MF, Chandratheva A ve ark. Effect of urgent treatment of transient ischaemic attack and minör stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet2007; 370(9596):1432–42. 5.Bild DE, Bluemke DA, Burke GLve ark. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871–881. 6.Patton N, Aslam T, Macgillivray T, Pattie A, Deary IJ, Dhillon B. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat. 2005;206(4):319–348. 7.Mitchell P, Wang JJ, Wong TY, Smith W, Klein R, Leeder SR. Retinal microvascular signs and risk of str o k e a n d str o k e mo rt a lit y. Ne u r o l o g y. 2005;65(7):1005–1009. 8.Baker ML, Hand PJ, Wang JJ, Wong TY. Retinal signs and stroke: revisiting the link between the eye and brain. Stroke. 2008;39(4):1371–1379. 9.Brown RD, Petty GW, O'Fallon WM, Wiebers DO, Whisnant JP. Incidence of transient ischemic attack in Ro c h e st e r, Mi n n e s o t a , 1 9 8 5 - 1 9 8 9 . Str o k e 1998;29(10):2109-13. 10.Fisher M. Transient monocular blindness associated with hemiplegia. Arch Ophthalmol 1952;47(2):167-203. 11.Smit RLM, Baarsma GS, Koudsstaal PJ. The source of embolism in amaurosis fugax and retinal artery occlusion. Int Ophthalmol 1994;18(2):83-6. 12.Ellenberger C, Epstein AD. Ocular complications of atherosclerosis:what do they mean? Semin Neurol 1986;6(2):185-93. 13.Castillo MM, Mowatt G, Lois N, Elders A ve ark. Optical coherence tomography for the diagnosis of neovascular age-related macular degeneration: a systematic review. Eye (Lond). 2014;28(12):1399-406. 14.Grewal DS, Tanna AP. Diagnosis of glaucoma and detection of glaucoma progression using spectral domain optical coherence tomography. Curr Opin Ophthalmol. 2013;24(2):150-61. 15.Yamashita T, Miki A, Iguchi Y, Kimura K, Maeda F, Kiryu J. Reduced retinal ganglion cell complex thickness in patients with posterior cerebral artery infarction detected using spectral-domain optical coherence tomography. Jpn J Ophthalmol. 2012;56(5):502-10. 16.Benavente O, Eliasziw M, Streifler JY, Fox AJ, Barnett HJ, Meldrum H. Prognosis after transient monocular blindness associated with carotidartery stenosis. N Engl J Med 2001;345(15):1084-90. 17.Batıoğlu F. Geçici görme kaybı ve karotis arter hastalığı. Turkiye Klinikleri J Surg Med Sci 2006,2(14):93-98. 18.Petzold A, de Boer JF, Schippling S ve ark. Optical coherence tomography in multiple sclerosis: a systematic review and meta-analysis. Lancet Neurol. 2010;9(9):921- 932. 19.Fisher JB, Jacobs DA, Markowitz CE ve ark. Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis. Ophthalmology. 2006;113(2):324- 332. 20.Costello F, Coupland S, Hodge W ve ark. Quantifying axonal loss after optic neuritiswith optical coherence tomography. Ann Neurol. 2006;59(6):963-969. 21.Burkholder BM, Osborne B, Loguidice MJ, et al. Macular volume determined by optical coherence tomography as a measure of neuronal loss in multiple sclerosis. Arch Neurol. 2009;66(11):1366-1372. 22.Paquet C,Boissonnot M,Roger F,Dighiero P,Gil R,Hugon J. Abnormal retinal thickness in patients with mild cognitive impairment and Alzheimer's disease. Neurosci Lett 2007;420(2):97-9. 23.Iseri P,Altinas O,Tokay T,Yuksel N. Relationship between cognitive impairment and retinal morphological and visual functional abnormalities in Alzheimer disease. J Neuroophthalmol 2006;26(1):18–24. 24.Altintas O, Iseri P, Ozkan B, Caglar Y. “Correlation between retinal morphological and functional findings and clinical severity in Parkinsons Disease,” Documenta Ophthal. 2006;116(2):137–146. 25.Aaker GD, Myung JS, Ehrlich JR, Mohammed M, Henchcliffe C, Kiss S. “Detection of retinal changes in Parkinson's disease with spectral-domain optical coherence t o m o g r a p h y , ” C l i n i c a l O p h t h a l m o l o g y , 2010;4(4):1427–1432.