Optical coherence tomography in differential diagnosis of optic neuropathy of various genesis
Authors:   Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation, Zhukova S.I. , Samsonov D.Yu. ,   Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation, Yurieva T.N. ,   Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation,   Irkutsk State Medical Academy of Professional Education — Branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russian Federation,   Irkutsk State Medical University, Irkutsk, Russian Federation, Prozorova T.V. ,   Irkutsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk, Russian Federation
Published: December 2024

Background: although thinning of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) revealed by optical
coherence tomography (OCT) are nonspecific data, they represent a key link in pathogenesis of optic neuropathy (ON) regardless of etiology.
Aim: to identify differences between OCT patterns of RNFL and GCC damages associated with ON of different genesis.
Patients and Methods: еxamination data of 58 patients with a suspected or preliminary diagnosed glaucoma who underwent an ophthalmic
examination in a glaucoma department were retrospectively analyzed. According to the findings, 2 groups were formed. A Group 1 included 19
patients with an initial stage of primary open-angle glaucoma. 12 patients with altered RNFL and GCC, ineligible for glaucoma ON (GON), were
enrolled in a non-glaucoma ON (non-GON) group. As a result of a detailed analysis of complaints, systemic and neurological status, chronic non-arteritic ischemic ON was diagnosed in 5 patients of the Group 2. In 7 patients, ON was associated with a history of optic neuritis with
underlying multiple sclerosis (MS). Thus, we are faced with ONs associated with glaucoma, ischemia and MS. Considering a fundamentally
different approach to treatment of these diseases and relevance of their differential diagnosis, a comparative analysis of ganglion cell axon
topography was carried out in 3 groups in the light of the medical condition (1 — glaucoma-associated lesions, 2 — ischemia-associated
lesions, 3 — MS-associated lesions).
Results: the most pronounced RNFL alterations were observed in lower and temporal quadrants (GON patients); upper and nasal quadrants
(ischemia patients); and in a temporal quadrant (MS patients). Retinal GCC lesions associated with GON and ischemia were asymmetric
(superior defects in glaucoma patients vs. inferior defects in ischemia ones). MS-associated macular lesions were symmetrical and outstripped
the RNFL alterations.
Conclusion: different patterns of peripapillary RNFL and macular GCC damages are caused by pathogenesis of primary neuronal damage.
These differences can be used as differential diagnostic criteria for GON and non-GON conditions in routine clinical practice.
KEYWORDS: optical coherence tomography, peripapillary retinal nerve fiber layer, macular ganglion cell complex, glaucoma ischemic optic
neuropathy, non-arterial ischemic opticopathy, retrobulbar neuritis, multiple sclerosis.
FOR CITATION: Zhukova S.I., Samsonov D.Yu., Yurieva T.N., Prozorova T.V. Optical coherence tomography in differential diagnosis of
optic neuropathy of various genesis. Russian Journal of Clinical Ophthalmology. 2024;24(4):170–176 (in Russ.). DOI: 10.32364/2311-
7729-2024-24-4-2