Prematurity Associated With Thinner Ganglion Cell Complex Layers

Tomography of eyes of a little girl patient. Advanced eye test equipment. Girl's face close up. Vision correction
Tomography of eyes of a little girl patient. Advanced eye test equipment. Girl’s face close up. Vision correction
Ganglion cell layer and inner plexiform layer thicknesses could potentially serve as a biomarker for brain damage.

Prematurity, younger gestational age (GA), and lower birth weight are associated with thinning of ganglion cell complex (GCC) layers, according to a study published in Acta Ophthalmologica

This cross sectional study included 49 children born full term and 101 children born prematurely with GA before 32 weeks or birth weight less than 1500g. Participants were between 4 years and 8 years of age at the time of examination. The investigators used high-quality optical coherence tomography (OCT) images to measure GCC and obtained data on neonatal and postnatal features from clinical records.  

Researchers found that the ganglion cell layer (GCL) and macular retinal nerve fiber layer (mRNFL) were thicker in children born full term compared with children born preterm (2.9 μm and 2.4 μm respectively, P <.001). The study also shows younger GA associated with a reduction in total GCL in the preterm group (0.7 μm per week, P <.001). Children who were small for GA experienced additional thinning in both layers (1.4 and 2.8 µm). 

Multivariable analysis confirmed that postnatal corticosteroids and severe brain lesion may be associated with thinning in the total GCL (6 µm [P <.001] and 4.1 µm [P =.002], respectively). The presence of neonatal shock was associated with thinning in total mRNFL (6 µm [P <.001]).

“Prematurity and its associated neonatal stressors should be taken into account when evaluating older children and adults with GCL-IPL or mRNFL thinning on OCT and that GCC thickness could be used as a brain damage biomarker in preterm children,” according to the researchers. 

Study limitations include a very narrow age range of participants. 


Ortueta-Olartecoechea A, Torres-Peña JL, Muñoz-Gallego A, et al. Retinal ganglion cell complex thickness at school-age, prematurity and neonatal stressors. Acta Ophthalmol. Published online December 6, 2021. doi:10.1111/aos.15073