Macular ganglion cells alteration in a patient with left homonymous hemianopia subsequent to surgical excision of an arteriovenous malformation

Abstract

Purpose: To report the case of a 57 years old woman who showed a macular ganglion cell complex (GCC), that is a combination of ganglion cell layer and inner plexiform layer, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness reduction in association with left homonymous hemianopia subsequent to surgical excision of an arteriovenous malformation in the cerebral right occipital lobe 37 years before.

Observations: One patient with left homonymous hemianopia due to surgical excision of an arteriovenous malformation in the right cerebral occipital lobe came to our attention for transient blurred vision.Measurement of the GCC and pRNFL thickness was performed using spectral domain optical coherence tomography (SDOCT; Cirrus HD-OCT model 400). Visual field (VF) defects were assessed using Humphrey field analyzer using the central 30-2 Swedish Interactive Threshold Algorithm (SITA) program with appropriate trial lenses (Humphrey Field Analyzer II, Carl Zeiss Meditech, Inc, Dublin, California).The average pRNFL thickness was bilaterally reduced, showing a symmetry value of 39%. The patients showed a significant GCC thinning in the projecting sector of the retina mapping to the brain lesion. Corresponding VF defects were found.

Conclusions and importance: These findings show SDOCT potentials in the field of neuro-ophthalmology, supporting the usefulness of GCC thickness as a possible imaging marker before and after brain surgery, and, possibly, in the diagnosis of neurodegenerative conditions.

Keywords: Arteriovenous malformation; GCC; Hemianopia; Neuro-ophthalmology; Neurodegenerative diseases; OCT; Retrograde transneural degeneration; pRNFL.

Fig. 1

Fundus oculi photographs of the right eye (RE) and left eye (LE).

Fig. 2

Retinal Nerve Fiber Layer Thickness Analysis report.

Fig. 3

Ganglion Cells Analysis report.

Fig. 4

Humphrey visual field results of the right eye (destra) and left eye (sinistra).

Fig. 5

Brain imaging scans showing excision positioning at different levels.