Teaching NeuroImage: Ganglion Cell Patterns Localize Anterior Visual Pathway Lesions

Measurement of retinal ganglion cell layer thickness by optical coherence tomography provides an objective and reliable evaluation of anterior visual pathway lesions to complement visual field testing in the management of optic chiasm compression from pituitary tumors.1,2 We demonstrated 3 differing patterns of ganglion cell layer thinning—junctional (figure 1, A and D), binasal (figure 1, B and E), and homonymous (figure 1, C and F)—and illustrated how these patterns correspond to the location of chiasmal compression by pituitary adenomas, anteriorly (figure 2A), centrally (figure 2B), or posteriorly (figure 2C). Consideration of the pattern of ganglion cell layer thinning in conjunction with visual field testing is useful for predicting the location of anterior visual pathway lesions.

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