Correlation Between Retrograde Trans-Synaptic Degeneration of Ganglion Cells and Optical Coherence Tomography Angiography Following Ischemic Stroke

Abstract

Objective Following nerve injury, the projection of posterior visual pathway lesions into the macular ganglion cell layer (GCL) region indicates retrograde trans-synaptic degeneration (RTSD) as a mechanism of functional damage. Our purpose is to assess GCL damage and the impacts of ischemic brain lesions affecting the visual pathway on macular microvascularization in patients with stroke. Methods In a case-control study, we examined 15 ischemic stroke patients who showed visual field defects and 50 healthy controls using the high-resolution optical coherence tomography (OCT) techniques such as spectral domain-OCT (SD-OCT) to measure retinal nerve fiber layer (RNFL) and GCL thicknesses, and OCT angiography (OCTA) to assess damage to the macular microvasculature. Results In the cases, the correlation was detected among the site of vascular damage, visual field defect, retinal GCL thinning, and normal RNFL thickness. Further observations were significant reductions in macular thickness, GCL thickness, outer retinal layer vascular density, and vascular area in deeper retinal layers (p < 0.05). Conclusion Our findings suggest that ocular microvasculature abnormalities could serve as diagnostic and/or prognostic markers in patients with stroke and support the described use of GCL thickness as an image marker of visual pathway RTSD after brain injury.

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“…Multiple studies have found significant changes in both the SRL and DRL in patients with stroke. A case-control study with 15 ischemic stroke patients found that VD was significantly reduced at the level of all vascular plexuses in stroke patients [53]. Additionally, a study by Liang et al [54] in 2022 found that the VD in the SCP and DCP was significantly reduced in ischemic stroke patients compared to those in the control [54].…”

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“…Additionally, DRCP VD and vascular area (VA) was found to be reduced, along with a decrease in the outer retina layer VD. The total of RPC, SCP, and ICP VA was reduced [238]. Liang et al found that GCC and RNFL thickness were reduced, and SRCP, DRCP, and RPC VD were generally lower in ischemic stroke patients compared to HC [239].…”

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“…The regression analyses confirmed that OCT-A was able to distinguish stroke patients from controls with good sensitivity and specificity. Molero-Senosiain et al performed OCT-A in stroke patients with ischemic lesions affecting the visual pathway and in a healthy control group [ 55 ]. All included stroke patients had partial visual field defects as a consequence of the ischemic attack.…”

“…Compared to the control group, the vessel density was reduced in all vascular plexuses in the macular and peripapillary regions. The authors do not report more pronounced microvascular changes in areas corresponding to the visual field defects, but the thickness of the GCL correlated with the visual field defects [ 55 ].…”