Q 1 – What constitutes Ganglion Cell Complex?
1 Retinal nerve fiber layer (RNFL)
2 Ganglion cell layer
3 Inner plexiform layer
4 All of the above.
Q 2 -Early structural damage in glaucoma may be better diagnosed with which of the following parameters?
1 Macular ganglion cell -inner plexiform layer (GC-IPL)
2 Circumpapillary Retinal nerve fiber layer (cpRNFL)
3 Cup disc ratio
4 Both a and b
Q 1 Answer: 4.
The retinal nerve fiber layer (RNFL), is composed of ganglion cell axons, neuroglia, and astrocytes;
the ganglion cell layer (GCL), which is composed of cell bodies,; and the inner plexiform layer (IPL), which
contains the retinal ganglion cell dendrites form the ganglion cell complex (GCC). This GCC preferentially
gets affected in glaucoma.
Q 2 Answer- 1.
In early glaucoma, macular GCIPL change is frequently detected before corresponding changes in the retinal nerve fiber layer. This could be the result of a superior sensitivity of the mGCIPL deviation map that may allow the detection of an abnormality in the mGCIPL thickness earlier. So, focusing on OCT pRNFL analysis alone can lead to the missing of macular damage. Macular OCT imaging should be included in the imaging algorithm for the serial observation of patients with glaucoma. However, the Retinal nerve fiber layer is also an important structural parameter that should also be assessed in early and moderate glaucoma. In advanced glaucoma, due to the extreme thinning of the RNFL, it may no longer be possible to follow progressive damage. This is called the flooring effect of the retinal nerve fiber layer. It is also important that when both the tests are done, one should attempt to make a structure correlation between the GC-IPL and the RNFL to yield additional information both for assessing the structural damage and for further follow-up of progression.