Comparison of Ganglion Cell-Inner Plexiform Layer and Retinal Nerve Fiber Layer after Cataract Surgery

Young Soo Han; Pyung Lee; Kyung Hyun Jin

doi:10.7469/JKOS.2015.56.04.485

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Han, Lee, and Jin: Comparison of Ganglion Cell-Inner Plexiform Layer and Retinal Nerve Fiber Layer after Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2015;56(4):485-493.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.485

Comparison of Ganglion Cell-Inner Plexiform Layer and Retinal Nerve Fiber Layer after Cataract Surgery

Young Soo Han, MD, Pyung Lee, MD, Kyung Hyun Jin, MD, PhD

Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea

￭ Address reprint requests to Kyung Hyun Jin, MD, PhD Department of Ophthalmology, Kyung Hee University Medical Center, #23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Korea Tel: 82-2-958-8451, Fax: 82-2-966-7340 E-mail: khjinmd@khmc.or.kr

Received 14 August 20148 October 2014 Accepted 7 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

To observe the change in the measured thickness of ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) thickness before and after cataract surgery.

Methods:

Forty-six eyes of 32 patients, scheduled to have cataract surgery, were imaged with spectral-domain optical coherence tomography (OCT) (Cirrus HD OCT) before and 5 weeks after the surgery to measure GCIPL and RNFL thickness repeatly. Results: All GCIPL and RNFL thickness parameters were significantly higher postoperatively compared with preoperative measurements ( p < 0.001). RNFL thickness changed more than GCIPL; the increased amount of mean RNFL thickness (14.16%) was higher than GCIPL thickness (7.36%; p < 0.001). GCIPL and RNFL thicknesses and, GCIPL signal strength changes were significantly increased in all types of cataracts ( p < 0.05). RNFL signal strength change was significantly increased in posterior subcapsular cataracts ( p < 0.05).

Conclusions:

Cataracts may affect GCIPL and RNFL thicknesses. After cataract surgery, GCIPL thickness, similar to the RNFL thickness, was increased significantly. As GCIPL thickness may be less affected by cataracts than RNFL thickness, GCIPL thickness may be a more meaningful indicator for the diagnosis of glaucoma with cataract.

Keywords: Cataract surgery, Ganglion cell-inner plexiform layer, Glaucoma diagnosis, Optical coherence tomography

References

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Figure 1.

Cirrus HD-OCT images of the macula of the right eye. (A) GCIPL thickness maps (the denser the orange/yellow ring, the thicker the GCIPL) (B) Boundary lines drawn to measure GCIPL thickness. The pur-ple line indicates the boundary between the RNFL and GCL. And the yellow line indicates the boundary between the IPL and INL. (C) GCIPL division map. The significance map shows (clockwise) thickness of the superior, superonasal, inferonasal, inferior, inferotemporal, and superotemporal sectors of the annulus and the average and minimum GCIPL (box) (D) GCIPL deviation map. GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; HD-OCT = high definition-OCT; GCL = ganglion cell layer; IPL = inner plexiform layer; INL = inner nuclear layer.

Figure 2.

GCIPL and RNFL thickness measurement before (A) and after (B) cataract surgery. RNFL thickness measurement before (C) and after (D) cataract surgery. After cataract surgery, both GCIPL and RNFL thickness were increased. GCIPL thickness was less changed than RNFL. GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; GCL = ganglion cell layer; IPL = inner plexiform layer; C/D = cup/disc; N = nasal; S = superior; T = temporal; I = inferior.

Table 1.

Clinical characteristics of study participants

Numbers (eyes:patients)	46:32
Age (years)	65.53 ± 8.95
Sex (M:F)	10:22
Eye (right:left:both)	10:8:14
IOL (IQ:ZCB00:MI60)	13:22:11
Diabetes mellitus (yes:no)	9:23
Hypertension (yes:no)	12:20
Preoperative IOP (mm Hg)	13.38 ± 3.39
Postoperative IOP (mm Hg)	11.17 ± 2.96
Postperative absolute RE (diopter)	0.46 ± 0.25
Preoperative BCVA (log MAR)	0.29 ± 0.30
Postoperative BCVA (log MAR)	0.06 ± 0.09
Types of lens opacities (cortical:nuclear:posterior)	22:13:11
Follow up (days)	39.80 ± 12.44
Axial length (mm)	23.55 ± 0.96

Values are presented as mean ± SD unless otherwise indicated.

IOL = intra ocular lens; IOP = intraocular pressure; RE = refractive equivalent; BCVA = best corrected visual acuity.

Table 2.

Preoperative and postoperative GCIPL and RNFL measurements in eyes

	Before surgery	After surgery	Change rate (%)	p-value
GCIPL parameters
SS	7.7 ± 1.2	8.8 ± 1.0	17.9 ± 20.0	<0.001
Average (μ m)	76.5 ± 9.4	83.5 ± 6.4	7.4 ± 4.0	<0.001
Superotemporal (μ m)	77.0 ± 9.0	84.6 ± 8.8	8.6 ± 9.3	<0.001
Superior (μ m)	77.4 ± 9.4	84.0 ± 6.4	7.1 ± 4.6	<0.001
Superonasal (μ m)	78.4 ± 11.0	85.7 ± 6.8	7.3 ± 4.6	<0.001
Inferonasal (μ m)	75.6 ± 10.7	82.1 ± 6.4	7.0 ± 7.1	<0.001
Inferior (μ m)	73.5 ± 10.3	78.8 ± 8.2	5.0 ± 5.1	<0.001
Inferotemporal (μ m)	76.8 ± 9.3	84.5 ± 7.6	8.3 ± 8.4	<0.001
RNFL parameters
SS	6.9 ± 1.0	7.9 ± 1.0	15.5 ± 20.3	<0.001
Average (μ m)	87.9 ± 7.9	100.4 ± 10.2	14.2 ± 7.2	<0.001
Superior (μ m)	111.5 ± 13.9	127.7 ± 17.4	14.6 ± 8.3	<0.001
Nasal (μ m)	62.9 ± 8.1	72.9 ± 9.0	16.5 ± 12.9	<0.001
Inferior (μ m)	112.9 ± 14.2	127.0 ± 16.6	12.6 ± 7.9	<0.001
Temporal (μ m)	64.2 ± 9.5	73.7 ± 10.5	15.6 ± 11.6	<0.001

Values are presented as mean ± SD.

GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; SS = signal strength.

Table 3.

Comparison between GCIPL and RNFL measurements in eyes

	GCIPL	RNFL	p-value
Preoperative signal strength	7.7 ± 1.2	6.9 ± 0.9	<0.001
Average postoperative signal strength change (%)	17.9 ± 20.0	15.5 ± 20.3	0.451
Average postoperative thickness change (%)	7.4 ± 4.0	14.2 ± 7.2	<0.001

Values are presented as mean ± SD unless otherwise indicated.

GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer.

Table 4.

Mean and standard deviation (SD) of SS, average GCIPL and RNFL thickness analysis in types of cataract

	Before surgery	After surgery	Change rate (%)	p-value
Coritical (n = 22)
SS GCIPL	7.6 ± 1.2	8.8 ± 1.0	19.0 ± 22.4	<0.05
Average GCIPL (μ m)	78.2 ± 5.5	84.2 ± 6.1	8.5 ± 3.2	<0.05
SS RNFL	6.9 ± 0.9	7.8 ± 1.0	9.4 ± 20.6	0.081
Average RNFL (μ m)	87.6 ± 7.8	100.2 ± 9.9	15.6 ± 6.6	<0.05
Nuclear (n = 13)
SS GCIPL	7.8 ± 1.2	8.9 ± 1.0	11.5 ± 9.9	<0.05
Average GCIPL (μ m)	78.3 ± 5.8	83.6 ± 6.8	6.0 ± 4.1	<0.05
SS RNFL	6.9 ± 0.9	7.9 ± 1.0	18.2 ± 20.2	0.11
Average RNFL (μ m)	87.8 ± 8.2	99.2 ± 10.0	14.3 ± 8.0	<0.05
Post subcapsular (n = 11)
SS GCIPL	7.8 ± 1.1	8.9 ± 1.0	24.2 ± 23.7	<0.05
Average GCIPL (μ m)	79.1 ± 5.2	84.4 ± 6.4	6.7 ± 4.8	<0.05
SS RNFL	7.0 ± 0.9	8.0 ± 1.0	24.0 ± 17.2	<0.05
Average RNFL (μ m)	88.3 ± 7.8	99.8 ± 10.0	11.2 ± 7.3	<0.05

Values are presented as mean ± SD.

GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; SS = signal strength.

Table 5.

Pearson correlation between change in signal strength (GCIPL, RNFL) and other factors

Variables	Change in GCIPL signal strength		Change in RNFL signal strength
Variables	r	p-value	r	p-value
Age (years)	0.046	0.770	-0.133	0.394
Preoperative VA (log MAR)	0.004	0.981	-0.139	0.375
Preoperative SS	-0.725	<0.001	-0.652	<0.001
Axial length	-0.317	0.039	-0.175	0.263
Preoperative IOP	0.362	0.017	0.273	0.076
Postoperative IOP	0.204	0.190	0.196	0.207
IOP change	-0.179	0.251	-0.096	0.540

GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; VA = best corrected visual acuity; SS = signal strength; IOP = intraocular pressure.

Table 6.

Pearson correlation between change in average thickness measurement (GCIPL, RNFL) and other factors

Variables	Change in average GCIPL thickness		Change in average RNFL thickness
Variables	r	p-value	r	p-value
Age (years)	-0.231	0.137	-0.255	0.099
Preoperative VA (log MAR)	0.319	0.037	0.050	0.749
Preoperative SS	-0.308	0.044	-0.152	0.332
SS change	-0.027	0.866	-0.007	0.967
Preoperative average thickness	-0.104	0.507	-0.196	0.209
Axial length	0.156	0.318	0.216	0.165
Preoperative IOP	-0.344	0.024	-0.472	0.003
Postoperative IOP	-0.312	0.041	-0.540	0.010
IOP change	0.062	0.694	-0.017	0.914

GCIPL = ganglion cell-inner plexiform layer; RNFL = retinal nerve fiber layer; VA = best corrected visual acuity; SS = signal strength; IOP = intraocular pressure.

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