Parija S, Chakraborty K, Sahu RN, Nayak B, Rathod RS. Ganglion cell complex and retinal nerve fiber layer thickness in predicting visual outcome in brain tumors after surgery. World J Exp Med 2025; 15(4): 108702 [DOI: 10.5493/wjem.v15.i4.108702]
Corresponding Author of This Article
Sucheta Parija, Head, Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Patrapada, Bhubaneshwar 751019, Odisha, India. ophthal_sucheta@aiimsbhubaneswar.edu.in
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sucheta Parija, Bhagabat Nayak, Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India
Koyel Chakraborty, Department of Ophthalmology, All India Institute of Medical Sciences Kalyani, Kolkota 741245, West Bengal, India
Rabi Narayan Sahu, Department of Neurosurgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
Ravikumar Subraya Rathod, Department of Community Medicine, Government Medical College and Hospital, Chandigarh 160030, Chandīgarh, India
Co-first authors: Sucheta Parija and Koyel Chakraborty.
Author contributions: Parija S contributed to conceptualization of idea, writing and editing; Chakraborty K contributed to data collection, writing and editing; Sahu RN contributed to data collecting, editing; Nayak B contributed to editing of article; Rathod RS contributed to statistical analysis and formatting.
Institutional review board statement: The approval of this ethics protocol was granted by the All India Institute of Medical Sciences.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No data shared.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sucheta Parija, Head, Professor, Department of Ophthalmology, All India Institute of Medical Sciences, Patrapada, Bhubaneshwar 751019, Odisha, India. ophthal_sucheta@aiimsbhubaneswar.edu.in
Received: April 22, 2025 Revised: June 10, 2025 Accepted: September 16, 2025 Published online: December 20, 2025 Processing time: 242 Days and 11.9 Hours
Abstract
BACKGROUND
Anterior visual pathway lesions can cause severe visual loss. Optical coherence tomography (OCT) can detect ganglion cell complex (GCC) thinning, even with normal retinal nerve fiber layer (RNFL) thickness and subtle visual field changes.
AIM
To determine the proportion of eyes with RNFL and GCC thinning and their association with visual parameters in patients with brain tumors undergoing surgery.
METHODS
A prospective study was conducted on 37 patients (69 eyes) with peri-chiasmatic and chiasmatic brain tumors undergoing surgical decompression between February 2019 and June 2020 at a tertiary care institute. A comprehensive neuro-ophthalmological work-up, demographic and clinical profile documentation, and six-month postoperative follow-up weredone. Statistical analysis was significant at P < 0.05.
RESULTS
Mean age was 35.14 ± 11.98 years. The best and worst visual outcomes were associated with the craniopharyngioma and meningioma groups, respectively (P = 0.008). There was an increase in the proportion of eyes with RNFL damage in the inferior quadrant (P = 0.02). Maximum GCC thickness thinning was associated with severe visual impairment. The odds of having blindness in eyes with RNFL (inferior) and GCC loss were 0.96 (P = 0.003) and 0.95 (P = 0.03), respectively. GCC thickness showed a clinically positive correlation with visual acuity (r = -0.48, P < 0.001) and field defect (r = -0.27, P = 0.04) at six months postoperatively. The preoperative GCC thickness and the final postoperative visual outcome were plotted in an empirical ROC curve with area under the curve = 0.754. The cut-off value of RNFL (inferior) and GCC, beyond which blindness could be prevented, was 73 µm and 58 µm, respectively.
CONCLUSION
In chiasmal compression, RNFL and GCC thickness measurements using OCT can be a useful prognostic indicator for assessing visual recovery. An eye with structural damage, with significant RNFL and GCC loss, is a predictive factor of blindness. A minimum preoperative RNFL and GCC thickness of 73 µm and 58 µm, respectively, can preserve vision after surgery.
Core Tip: This study was conducted among perichiasmatic brain tumor patients in which optical coherence tomography was used to detect ganglion cell complex (GCC) and retinal nerve fibre layer (RNFL) damage as well as prognosticate visual outcome. A positive correlation was noted between GCC thickness, visual acuity and field defect at six months postoperatively. The predictors of blindness were reduced baseline GCC and RNFL thickness. A minimum cut-off value predicting preservation of vision was a RNFL thickness of 73 µm and a GCC thickness of 58 µm. Hence, it can guide early intervention by a neurosurgeon for vision preservation.
