Fig 1.
Flowchart of the subjects.
Fig 2.
The OCT macular scanning protocol.
The protocol consisted of 19 vertical scan lines (white arrows) over macular area. The scan was centered on the fovea and had a height of 30° and a width of 15°. Each of the 19 line scans was obtained by averaging 50 B-scans.
Fig 3.
The left fundus of a 44-year-old woman with primary open angle glaucoma and microcystic inner nuclear layer (INL) lesions.
A, Infrared image shows perimacular hyporeflective patterns in the region with INL microcystic lesions (white arrows). B, C, Fundus (B) and red-free (C) photographs show retinal nerve fiber layer defects (NFLD, white arrows). Disc hemorrhage was also present at the upper NFLD. D, A Spectralis optical coherence tomography (OCT) image along the yellow line in A shows microcystic INL lesions (yellow arrows). The INL is thicker and the retinal nerve fiber and ganglion cell layers are thinner in the microcystic lesion area. This eye had a partial posterior vitreous detachment (white arrows). E, Pattern deviation map from Humphrey Visual Field Analyzer testing (24–2 Swedish interactive threshold algorithm standard program) showing visual field defects. An absolute scotoma at the superonasal test points closest to fixation corresponds to the location of the lower NFLD and microcystic INL lesions. F, Magnified OCT image (yellow box in D).
Fig 4.
Right fundus of a 29-year-old woman with primary open angle glaucoma and microcystic inner nuclear layer (INL) lesions.
A, The infrared image shows a perimacular hyporeflective pattern in the region with INL microcystic changes (white arrow). B, A fundus photograph shows no evident retinal nerve fiber defect (NFLD). C, A red-free photograph shows NFLD in the region of microcystic INL changes (white arrows). D, A Spectralis optical coherence tomography (OCT) image along the yellow arrow in A shows microcystic INL lesions (yellow arrows). The INL is thicker and the retinal nerve fiber and ganglion cell layers are thinner in the region with microcystic lesions. This eye had a partial posterior vitreous detachment, with the vitreous still attached to the retinal surface above the microcystic lesions (white arrows). E, Pattern deviation map from Humphrey Visual Field Analyzer testing (24–2 Swedish interactive threshold algorithm standard program) showed superior visual field defects. An absolute scotoma was present at the superonasal test points closest to the fixation. F, A magnified OCT image (yellow box in D).
Table 1.
Clinical Characteristics of the Subjects.
Table 2.
Comparison of Subject Characteristics between Primary Open Angle Glaucoma Patients With and Without Microcystic Inner Nuclear Layer Lesion
Fig 5.
Changes over time in an eye with microcystic inner nuclear layer (INL).
Changes appearing before significant visual field damage occurred. A-D, E-H and I-L show images and testing obtained in December of 2008, 2012, and 2013, respectively. A, E, I, Infrared images showed perimacular hyporeflective patterns (arrow heads) becoming more obvious over time. B, C, F, G, J, K, Spectralis OCT images oriented along arrows in A, E and I. D, H and L, Standard automated perimetry testing results (Humphrey Visual Field Analyzer, 24–2 Swedish interactive threshold algorithm standard program gray scale). Subtle microcystic changes were observed in INL (B, C). It was noticed that localized thinning of retinal nerve fiber layer and ganglion cell layer existed though no severe visual field defects were present (B, C and D). Microcystic changes became more distinct as visual field defects progressed (F, G and H). Microcystic lesion changes became less apparent (F, G, J and K) while the visual field remained stable (H, L).
Fig 6.
Comparison of retinal nerve fiber layer (RNFL), ganglion cell complex plus inner plexiform layer (GCC+IPL), inner nuclear layer (INL), and outer retinal thickness between at sites with and without microcystic changes.
Measurements were taken at the opposite and equidistant site from a horizontal line passing through the foveal center (red line in A) for sites with and without INL lesions. A, An infrared fundus image shows measurement points (white arrows). B, A Spectralis optical coherence tomography (OCT) image along the yellow arrow in A. The RNFL (red bars), GCL+IPL (green bars), INL (yellow bars) and outer retinal thickness (brown bars) measured at sites with and without microcystic lesions (white arrows) and are shown in parts in C, D, E and F, respectively.