Abstract

Short Communication

Clinically Observable Ocular Manifestations of Axonal Transport

Don Minckler*, Ken Y Lin and Michael C Yang

Published: 25 September, 2023 | Volume 7 - Issue 2 | Pages: 006-007

This report illustrates and provides a novel explanation for post-trabeculectomy improvements in the visual field, cup disc contours, and apparent deepening of an arcuate nerve fiber layer (NFL) defect after trabeculectomy for open-angle glaucoma. These changes are all plausible manifestations of recovered axonal transport and thickening retina, previously thinned by elevated intraocular pressure (IOP). Serial pre-and post-operative clinical fundus photos in case 1(A,B) demonstrate increased prominence of an inferior temporal arcuate nerve fiber layer defect, improved cup disc ratio, and visual field following eye pressure lowering by + 50% after trabeculectomy. Case 2 (C,D) also demonstrates obvious cup disc improvement in post-operative photos with associated improvement in visual field after trabeculectomy and lowering IOP by + 30%. We suggest that elevated IOP suppresses primarily orthograde axonal transport resulting in nerve fiber layer (NFL) thinning that can recover back to normal thickness when IOP is surgically lowered by the magnitude achieved in these two examples.

Read Full Article HTML DOI: 10.29328/journal.ijceo.1001052 Cite this Article Read Full Article PDF

Keywords:

Axonal transport; Chronic open-angle glaucoma; Intraocular pressure; Visual fields; Cup/disc ratio; Nerve fiber layer defect

References

  1. Minckler DS, Bunt AH, Johanson GW. Orthograde and retrograde axoplasmic transport during acute ocular hypertension in the monkey. Invest Ophthalmol Vis Sci. 1977 May;16(5):426-41. PMID: 67096.
  2. Minckler DS, Brown DJ, Nalbandian A, Suh DW. Amyloid Precursor Protein in Abusive Head Trauma Suspects. Am J Ophthalmol. 2022 Aug;240:58-66. doi: 10.1016/j.ajo.2022.02.018. Epub 2022 Mar 2. PMID: 35247337.
  3. Quigley HA. Childhood glaucoma: results with trabeculotomy and study of reversible cupping. Ophthalmology. 1982 Mar;89(3):219-26. doi: 10.1016/s0161-6420(82)34803-4. PMID: 7088505.
  4. Katz LJ, Spaeth GL, Cantor LB, Poryzees EM, Steinmann WC. Reversible optic disk cupping and visual field improvement in adults with glaucoma. Am J Ophthalmol. 1989 May 15;107(5):485-92. doi: 10.1016/0002-9394(89)90492-3. PMID: 2712131.
  5. Yildirim E, Bilge AH, Ilker S. Improvement of visual field following trabeculectomy for open angle glaucoma. Eye (Lond). 1990;4 ( Pt 1):103-6. doi: 10.1038/eye.1990.12. PMID: 2323460.
  6. McLeod D. Why cotton wool spots should not be regarded as retinal nerve fibre layer infarcts. Br J Ophthalmol. 2005 Feb;89(2):229-37. doi: 10.1136/bjo.2004.058347. PMID: 15665358; PMCID: PMC1772507.

Figures:

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