Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fibre Layer Changes in Patients With Thyroid Eye Disease Without Optic Neuropathy: A Retrospective Observational Study

TL;DR

This study examines retinal changes in thyroid eye disease patients without optic nerve damage to detect early signs of vision loss.

Contribution

The study identifies potential subclinical retinal changes in TED patients before optic neuropathy symptoms appear.

Findings

Patients with elevated IOP showed thinner RNFL and GCL-IPL thickness, though not statistically significant.

Male patients had significantly higher GCL-IPL thickness in specific retinal sectors.

Age was negatively correlated with GCL-IPL thickness in certain regions.

Abstract

Background: Thyroid eye disease (TED) is an autoimmune inflammatory disorder affecting orbital tissues and can lead to optic nerve damage. Early detection of retinal changes before clinical signs of optic neuropathy is crucial to prevent vision loss.

Objective: To evaluate macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with TED without clinical signs of optic neuropathy.

Methods: A retrospective observational study was conducted at All India Institute of Medical Sciences, Raebareli, India, between January 2024 and January 2025. Patients with TED and best-corrected visual acuity (BCVA) of 6/9 or better were included. Based on intraocular pressure (IOP), gender, and age, patients were categorized to assess their association with structural retinal parameters. Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate GCC and RNFL thickness.

Results: The mean age of 50 patients enrolled in the study was 43.03 ± 1.79 years. The majority (84%) of the patients were females. Although not statistically significant, patients with elevated IOP had lower RNFL and GCC-inner plexiform layer (GCL-IPL) thickness. Male patients exhibited significantly higher GCL-IPL thickness in the inferotemporal and superotemporal sectors. Age was negatively correlated with GCL-IPL thickness, particularly in the inferotemporal and superotemporal regions.

Conclusion: TED patients with elevated IOP, increasing age, and female gender exhibited thinner RNFL and GCL-IPL, though most differences were not statistically significant. These findings underscore the importance of early OCT monitoring in TED patients to detect subclinical optic nerve changes. Future longitudinal studies with larger sample sizes and appropriate control groups are needed to confirm these associations and to better establish causality.

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