Laws Elinor, Metry Youstina, Bin Saliman Noor Haziq, Belli Antonio, Blanch Richard J
Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Neuroscience and Ophthalmology, School of Infection, Inflammation and Immunology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Sci Rep. 2025 Apr 29;15(1):14992. doi: 10.1038/s41598-025-94091-1.
Retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thinning occur weeks to months after traumatic brain injury (TBI), even without computed tomography (CT) findings. The patterns of RNFL and GCL loss and their relationship to TBI severity and CT findings have not been characterised. This observational study included consecutive patients assessed in hospital after TBI. All patients underwent OCT. A literature review was conducted to determine the test-retest variability of RNFL and GCL measurements. Of 135 included patients, 62 had follow up OCTs. The test-retest limit of agreement for global RNFL thickness was 4 µm. Two patients had symptomatic traumatic optic neuropathy, 17 had less severe RNFL thinning on follow up, six RNFL thickening and 31 no RNFL changes. Higher TBI severity, Marshall CT classification and lower time to first OCT after injury strongly associated with subsequent RNFL changes (p < 0.001 for all). Global RNFL thickness in patients with initial OCT < 42 days after injury declined by 1.74 µm/month with Marshall II CT findings, compared 0.05 µm/month with Marshall I, and 3.69 µm/month after severe TBI, versus 1.47 µm/month after mild. Subclinical OCT changes therefore occur after TBI, and may contribute to future multimodal TBI diagnostic and severity assessments.
即使没有计算机断层扫描（CT）结果，视网膜神经纤维层（RNFL）和神经节细胞层（GCL）变薄也会在创伤性脑损伤（TBI）后数周数月出现。RNFL和GCL损失的模式及其与TBI严重程度和CT结果的关系尚未明确。这项观察性研究纳入了TBI后在医院接受评估的连续患者。所有患者均接受了光学相干断层扫描（OCT）。进行了文献综述以确定RNFL和GCL测量的重测变异性。在纳入的135例患者中，62例进行了OCT随访。全球RNFL厚度的重测一致性界限为4μm。两名患者患有症状性创伤性视神经病变，17例随访时RNFL变薄较轻，6例RNFL增厚，31例RNFL无变化。较高的TBI严重程度、Marshall CT分级以及受伤后首次OCT检查的时间较短与随后的RNFL变化密切相关（所有p值均<0.001）。受伤后初始OCT检查时间<42天的患者，Marshall II级CT表现的患者全球RNFL厚度每月下降1.74μm，Marshall I级为0.05μm/月，重度TBI后为3.69μm/月，轻度TBI后为1.47μm/月。因此，TBI后会出现亚临床OCT变化，这可能有助于未来多模式TBI诊断和严重程度评估。
