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Retrograde Degeneration of Retinal Ganglion Cells Secondary to Head Trauma

Vien, Lee*; DalPorto, Christina; Yang, David*

doi: 10.1097/OPX.0000000000000899
CLINICAL COMMUNICATIONS: Clinical Case
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Purpose To discuss the clinical case of a patient with transsynaptic retrograde degeneration (TRD) demonstrated by progressive retinal nerve fiber layer loss documented by serial spectral domain optical coherence tomography secondary to traumatic brain injury after 2 months post-trauma.

Case Report A 25-year-old Caucasian male patient presented to a polytrauma rehabilitation center (PRC) for evaluation and treatment secondary to a severe traumatic brain injury (TBI) from a motorcycle accident 2 months before. Spectral-domain optical coherence tomography (SD-OCT) was completed at intervals that ranged between 8 and 42 days for a duration of 119 days. A comparison to the pre-trauma SD-OCT 10 months before revealed progressive thinning of the retinal nerve fiber layer (RNFL) in both eyes over multiple follow-ups post-trauma. Humphrey visual field (HVF) testing revealed an incomplete congruous right homonymous hemianopsia that gradually improved over the follow-ups. Analysis of the macular ganglion cell-inner plexiform layer (GCIPL) thickness displayed loss that corresponded to the pattern of visual field defect.

Conclusions TRD can occur as soon as 2 months after severe TBI with damage posterior to the lateral geniculate nucleus. Progressive RNFL loss can be tracked with SD-OCT, and the rate of thinning may slowly stabilize over time. Visual field defects can improve months after the trauma but may not correspond to the progressive RNFL loss detected by SD-OCT.

*OD, FAAO

OD

Veterans Affairs Palo Alto Healthcare System, Palo Alto, California (LV, CDP, DY); and University of California, Berkeley School of Optometry, Berkeley, California (LV, DY).

Lee Vien VA Palo Alto Health Care System 3801 Miranda Ave (112/OPTOM) Palo Alto, CA 94304, e-mail: Lee.vien@va.gov

© 2017 American Academy of Optometry