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Diagnostic value of ganglion cell-inner plexiform layer for early detection of ethambutol-induced optic neuropathy
  1. Ju-Yeun Lee1,
  2. Jinu Han2,
  3. Jeong Gi Seo2,
  4. Kyung-Ah Park1,
  5. Sei Yeul Oh1
  1. 1 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  2. 2 Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
  1. Correspondence to Dr Sei Yeul Oh, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea; syoh{at}


Aim To evaluate the diagnostic value of macular ganglion cell-inner plexiform layer (mGCIPL) thickness versus peripapillary retinal nerve fibre layer (pRNFL) thickness for the early detection of ethambutol-induced optic neuropathy (EON).

Methods Twenty-eight eyes of 15 patients in the EON group and 100 eyes of 53 healthy subjects in the control group were included. All patients with EON demonstrated the onset of visual symptoms within 3 weeks. Diagnostic power for pRNFL and mGCIPL thicknesses measured by Cirrus spectral-domain optical coherence tomography was assessed by area under the receiver operating characteristic (AUROC) curves and sensitivity.

Results All of the mGCIPL thickness measurements were thinner in the EON group than in the control group in early EON (p<0.001). All of pRNFL thicknesses except inferior RNFL showed AUROC curves above 0.5, and all of the mGCIPL thicknesses showed AUROC curves above 0.5. The AUROC of the average mGCIPL (0.812) thickness was significantly greater than that of the average pRNFL (0.507) thickness (p<0.001). Of all the mGCIPL-related parameters considered, the minimum thickness showed the greatest AUROC value (0.863). The average mGCIPL thickness showed a weak correlation with visual field pattern standard deviations (r2=0.158, p<0.001).

Conclusions In challenging cases of EON, the mGCIPL thickness has better diagnostic performance in detecting early-onset EON as compared with using pRNFL thickness. Among the early detection ability of mGCIPL thickness, minimum GCIPL thickness has high diagnostic ability.

  • early diagnosis
  • ethambutol
  • optic neuropathy
  • imaging
  • ganglion cell

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  • J-YL and JH contributed equally.

  • Contributors J-YL and JH designed the study, input the data into the spreadsheet, conducted the statistical analysis, wrote the initial draft of the paper and revised the paper. JGS contributed to the acquisition of data. K-AP provided contributions during the revision of the initial draft. SYO revised the paper and gave final approval of the version to be published.

  • Funding This study was supported by a new faculty research seed money grant of Yonsei University College of Medicine for 2017 (2017-32-0038).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the institutional review board of Yonsei University Severance Hospital and followed the tenets of the Declaration of Helsinki (approval number: 4-2014-0552).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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