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Brief Report |

Paradoxical Changes of Retinal Nerve Fiber Layer Thickness in Uveitic Glaucoma

Sanjay Asrani, MD1; Daniel B. Moore, MD1; Glenn J. Jaffe, MD1
[+] Author Affiliations
1Duke University Eye Center, Durham, North Carolina
JAMA Ophthalmol. 2014;132(7):877-880. doi:10.1001/jamaophthalmol.2014.954.
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Importance  Measurement of retinal nerve fiber layer (RNFL) thickness using optical coherence tomography can aid in the diagnosis and management of glaucoma. We observed a previously unreported phenomenon in eyes with uveitis-associated glaucoma in which paradoxical changes in RNFL thickness were noted.

Observations  Four eyes of 3 patients with uveitis-associated glaucoma had a relatively normal RNFL measurement on presentation during periods of active uveitis and raised intraocular pressure. Subsequent control of uveitis and intraocular pressure was associated with a paradoxical thinning of the RNFL and increased cupping.

Conclusions and Relevance  Normal-appearing measurements of RNFL thickness in patients with uveitis should be interpreted cautiously in those with a raised intraocular pressure. Physicians should recognize that continued thinning of the RNFL and increased cupping, despite good intraocular pressure control in such eyes, may be due to resolution of edema of the RNFL.

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Figure 3.
Thickening Followed by Thinning of RNFL Measurements Associated With Flare-up and Control of Uveitis

A, Baseline retinal nerve fiber layer (RNFL) scan interpreted as normal. B, Follow-up 1 year later during mild uveitis flare-up demonstrating overall thickening of the RNFL. C, Repeat scan 1 month following resolution of uveitic activity with mild inferior thinning of the RNFL. D, Scan 2 months after trabeculectomy showing progressive RNFL thinning superotemporally and inferotemporally. E, Scan 5 months after trabeculectomy showing severe progressive RNFL thinning globally.

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Figure 2.
Sequential RNFL OCT Scans in Unilateral Anterior Uveitis

A, Baseline retinal nerve fiber layer (RNFL) scan demonstrating inferotemporal thinning. B, Follow-up 1 year later during mild uveitis flare-up with slight RNFL thickening compared with previously. C, Subsequent scan 6 months later after quiescence of uveitis with significant global thinning compared with previous scans.

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Figure 1.
Sequential RNFL OCT Scans in Bilateral Uveitis

A, Initial retinal nerve fiber layer (RNFL) scans 6 months after placement of a fluocinolone acetonide implant in both eyes. B, Follow-up scans 6 months later demonstrating early inferotemporal thinning and mild superotemporal thickening. C, Significant thinning 2 months later, following lowering of intraocular pressure (IOP) after bilateral glaucoma surgery both superotemporally and inferotemporally. D, Follow-up scans 3 months later with overall severe progressive thinning despite apparent control of IOP.

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