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Original Investigation |

Evaluation of Retinal Nerve Fiber Layer Thickness in Eyes With Hypertensive Uveitis

Norshamsiah M. Din, MD, MS(Ophth)1,2; Simon R. J. Taylor, PhD, FRCOphth1,3,4; Hazlita Isa, MBChB, MS(Ophth)1,2; Oren Tomkins-Netzer, MD, PhD1; Asaf Bar, MD1; Lazha Talat, MPH, MSc(Ophth)1; Sue Lightman, PhD, FRCOphth1
[+] Author Affiliations
1Institute of Ophthalmology, University College London, Moorfields Eye Hospital, London, England
2Department of Ophthalmology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
3Division of Immunology and Inflammation, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, England
4Department of Ophthalmology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, England
JAMA Ophthalmol. 2014;132(7):859-865. doi:10.1001/jamaophthalmol.2014.404.
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Importance  Uveitic glaucoma is among the most common causes of irreversible visual loss in uveitis. However, glaucoma detection can be obscured by inflammatory changes.

Objective  To determine whether retinal nerve fiber layer (RNFL) measurement can be used to detect glaucoma in uveitic eyes with elevated intraocular pressure (IOP).

Design, Setting, and Participants  Comparative case series of RNFL measurement using optical coherence tomography performed from May 1, 2010, through October 31, 2012, at a tertiary referral center. We assigned 536 eyes with uveitis (309 patients) in the following groups: normal contralateral eyes with unilateral uveitis (n = 72), normotensive uveitis (Uv-N) (n = 143), raised IOP and normal optic disc and/or visual field (Uv-H) (n = 233), and raised IOP and glaucomatous disc and/or visual field (Uv-G) (n = 88).

Exposures  Eyes with uveitis and elevated IOP (>21 mm Hg) on at least 2 occasions.

Main Outcomes and Measures  Comparison of RNFL values between groups of eyes and correlation with clinical data; risk factors for raised IOP, glaucoma, and RNFL thinning.

Results  Mean (SD) global RNFL was thicker in Uv-N (106.4 [21.4] µm) compared with control (96.0 [9.0] µm; P < .001) eyes and was thicker in Uv-N eyes with active (119.6 [23.2] µm) compared with quiescent (102.3 [20.8] µm; P = .001) uveitis, which in turn was not significantly different from control eyes (P = .07). Compared with Uv-N eyes, significant RNFL thinning was seen in all quadrants except the temporal in Uv-G eyes and significant thinning in the inferior quadrant of Uv-H eyes with no evidence of disc or visual field changes (P = .03). Risk factors for elevated IOP were male sex and anterior uveitis. Age, higher peak IOP, longer duration of follow-up, and uveitis-induced elevation of IOP were risk factors for glaucoma and RNFL defect.

Conclusions and Relevance  Screening for glaucomatous RNFL changes in uveitis must be performed during quiescent periods. Thinning of the inferior quadrant suggests that glaucomatous damage, more than uveitic ocular hypertension, is in fact occurring. Measurement of RNFL may detect signs of damage before disc or visual field changes and therefore identifies a subgroup that should receive more aggressive treatment.

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Figure 1.
Optical Coherence Tomography Printout

The right eye showed normal values (seen in 5%-95% of the population) of retinal nerve fiber layer (RNFL) thickness. The left eye showed RNFL thinning due to glaucoma. Numbers given with quadrants represent mean RNFL thickness; the number in the center represents the global (G) mean RNFL thickness. The superior (S) and inferior (I) quadrant RNFL thicknesses fall outside normal limits (seen in <1% of the population), and the nasal (N) quadrant RNFL thickness falls in the borderline thickness (seen in 1% to <5% of the population). ILM indicates internal limiting membrane; T, temporal quadrant.

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Figure 2.
Comparison of the Retinal Nerve Fiber Layer (RNFL) Thickness in Each Quadrant

We compared the normal contralateral eyes of patients with unilateral uveitis (controls) and eyes with normotensive uveitis (Uv-N). Error bars indicate 95% CI. NI indicates nasoinferior; NS, nasosuperior; TI, temperoinferior; TS, temperosuperior.aP < .05.bP < .01.cP < .001.

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