J Korean Ophthalmol Soc.  2020 Feb;61(2):214-220. 10.3341/jkos.2020.61.2.214.

Non-glaucomatous Retinal Nerve Fiber Layer Defect Associated with Paravascular Inner Retinal Defect

• Kim GJ
• Son DH
• Kim JS
• Shin MC

• KMID: 2470746
• DOI: http://doi.org/10.3341/jkos.2020.61.2.214

Abstract

PURPOSE
To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM).
CASE SUMMARY
A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary.
CONCLUSIONS
A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.

Keyword

Epiretinal membrane; Non-glaucomatous retinal nerve fiber defect; Paravascular inner retinal defect

MeSH Terms

Aged
Epiretinal Membrane
Glaucoma
Head
Humans
Intraocular Pressure
Male
Nerve Fibers*
Photography
Reference Values
Retinaldehyde*
Tomography, Optical Coherence
Visual Field Tests
Visual Fields
Retinaldehyde

Figure

• 

  Figure 1 Ophthalmic examinations performed at the first visit. (A, B) Disc photography of the patient shows intact neuroretinal rim (NRR) in the right eye and narrowing of superotemporal and inferotemporal NRR in the left eye. (C, D) Red-free fundus photography shows nasal extrafoveal epiretinal membrane with multiple retinal nerve fiber layer (RNFL) defect in the right eye that are not connected to the optic disc head border, and diffuse RNFL thinning in the left eye. (E) Circumpapillary scan image of spectral-domain optical coherence tomography of the right eye shows focal narrow RNFL thinning (marked as yellow line) just nasal to the superotemporal retinal venous arcade, which corresponds to the most nasally located slit-like RNFL defect seen in the red-free fundus photography. Other RNFL defects seen in the red-free fundus photography are not detected on the scan circle of 3.5 mm diameter. TS = superotemporal; NS = superonasal; T = temporal; N = nasal; G = general; TI = temporal inner; NI = nasal inner; TMP = temporal; SUP = superior; NAS = nasal; INF = inferior.

• 

  Figure 2 Comparisons between 2017 and 2019.(A) The en-face 52 µm slab image of swept-source optical coherence tomography (OCT) shows epiretinal membrane and paravascular inner retinal defect (PIRD) along the retinal vascular arcades. It also shows retinal nerve fiber layer (RNFL) defect connected to the PIRD, but not the optic disc head. There was no definite change in PIRD and RNFL defect between results of 2017 and 2019. (B) Red-free fundus photography also showed no change between 2017 and 2019. Note that locations of OCT B-scans in the en-face 52 µm slab image are also indicated as red horizontal lines in the red-free fundus photography. (C) Standard automated perimetry results did not show development of glaucomatous visual field defect between 2017 and 2019.

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