Acta Ophthalmologica 2014
Table 1. Detailed status of patients.
Letters to the Editor
Effect of hyperprolactina-
emia on intra-ocular
pressure
Georgios D. Panos and Zisis Gatzioufas
Department of Ophthalmology, Geneva
University Hospitals, Geneva,
Switzerland
doi: 10.1111/aos.12269
Editor,
W e have read with great interest
the article by Mansouri et al.
(2013) published in your journal. The
authors reported marked reduction in
intra-ocular pressure (IOP) in a female
patient during sexual activity with the
timing of the largest drop of the IOP
corresponding to the recorded moment
of orgasm. They hypothesized that the
rapid increase in prolactin and dopa-
mine levels occurring during orgasm
(Kruger et al. 2005) may have an IOP-
lowering effect resulting in immediate
reduction in the IOP in this distinct
patient. Actually, previous studies have
already reported the IOP-lowering
effect of dopamine in vivo, while low
IOP values have been correlated with
low prolactin levels in the plasma of
women with seasonal affective disorder
(Mekki & Turner 1985; Stojek et al.
1991).
Hereby, we would like to share our
experience of IOP measurements in
patients with hyperprolactinaemia, but
without any documented ocular pathol-
ogy. In a prospective case series of five
patients, data were collected for healthy
eyes in patients with hyperprolactina-
emia. Data included IOP and blood
prolactin levels. Mean IOP for the right
eyes (OD) was 8.4 mmHg and for the
left eyes (OS) 8 mmHg, which is signif-
icantly lower than the mean IOP of the
normal population (Leydhecker 1976).
Mean prolactin blood level was
432.4 ng/ml, while the normal range is
2–18 ng/ml in males and 2–29 ng/ml in
(non-pregnant) females. Significant neg-
ative correlation was found between
IOP and prolactin blood levels for both
eyes (OD: Pearson’s correlation coeffi-
IOP OD IOP OS Prolactin
Patient (mmHg) (mmHg) (ng/ml)
1 7 7 521
2 8 7 495
3 9 9 403
4 10 9 324
5 8 8 419
Mean  8.4  81 432.4 
SD 1.14 78.4
IOP, intra-ocular pressure.
cient, r = 0.9368, p = 0.019; OS: Pear-
son’s correlation coefficient, r = 0.922,
p = 0.026) suggesting that the higher the
levels of blood prolactin the lower the
IOP. Detailed status of patients is
depicted in Table 1.
These preliminary data are in agree-
ment with the clinical hypothesis of
Mansouri et al., indicating that sex
hormones such as prolactin, may have
an important role in the physiology of
IOP regulation. Of course, it should be
interesting to investigate IOP changes
in these patients after establishing nor-
mal levels of blood prolactin. Larger
studies are required to delineate the
exact nature of the IOP effects induced
by sex hormones such as prolactin.
References
Kruger TH, Hartmann U & Schedlowski M
(2005): Prolactinergic and dopaminergic
mechanisms underlying sexual arousal and
orgasm in humans. World J Urol 23: 130–138.
Leydhecker W (1976): The intraocular pres-
sure: clinical aspects. Ann Ophthalmol, 8:
389–392; 395–389.
Mansouri K, Medeiros FA & Weinreb RN
(2013): Intraocular pressure changes during
sexual activity. Acta Ophthalmol 91: e324–
e325.
Mekki QA & Turner P (1985): Stimulation of
dopamine receptors (type 2) lowers human
intraocular pressure. Br J Ophthalmol 69:
909–910.
Stojek A, Kasprzak B & Slabikowski A (1991):
Intraocular pressure and prolactin measures
in seasonal affective disorder. Psychiatr Pol
25: 8–12.
Correspondence:
Georgios D. Panos
Department of Ophthalmology
Geneva University Hospitals
Rue Alcide – Jentzer 22
1211 Geneva 14, Switzerland
Tel: + 41 79 55 34 739
Fax: + 41 22 382 83 82
Email: georgios.panos@hcuge.ch
Multicenter macular
ganglion cell analysis:
normative paediatric
reference range
Marta Galdos,1,2 Jes
us Barrio-Barrio,3
Susana Noval,4 Miguel Ruiz-Canela,5
Elvira Bonet,3 Mar
ıa Capote4 and
Estibaliz Garamendi2
1
Department of Ophthalmology, Cruces
University Hospital, Bilbao, Spain; 2Insti-
tuto Cl
ınico Quir

urgico Oftalmol

ogico
(ICQO), Bilbao, Spain; 3Department of
Ophthalmology, Cl
ınica Universidad de
Navarra, Pamplona, Spain; 4Department
of Ophthalmology, Hospital
Universitario La Paz, Autonomous
University of Madrid, IdiPaz, Madrid,
Spain; 5Department of Preventive
Medicine and Public Health, Universidad
de Navarra, Pamplona, Spain
doi: 10.1111/aos.12316
Editor,
R ecent advances in segmentation
algorithms have made possible
the visualization and measurement of
individual retinal layers with spectral-
domain optical coherence tomography
(SD-OCT). The ganglion cell-inner
plexiform layer (GCIPL) analysis in
the macula has become a relevant
examination in the assessment of dif-
ferent optic neuropathies (Syc et al.
2012; Renard et al. 2013). The GCIPL
thickness has been measured with Cir-
rus SD-OCT in healthy adults
(Mwanza et al. 2011; Koh et al.
2012). Likewise, analysis of discrete
retinal layers in 83 healthy children
using manual segmentation with Hei-
delberg Spectralis SD-OCT has
recently been published (Yanni et al.
2013).
The aim of the present study is to
provide reference ranges for GCIPL
thicknesses in children using the
automatic segmentation algorithm
available with the latest version of
Cirrus SD-OCT software (version 6.0;
Carl Zeiss Meditec, www.meditec.-
zeiss.com). This study is part of an
observational, multicenter and cross-
sectional study, among 283 healthy
Caucasian children aged 4–17 years
and recruited at three Spanish centres.
Detail study methods have been
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 Acta Ophthalmologica 2014

Table 1. Distribution of macular ganglion cell-inner plexiform layer (GCIPL) analysis using Cirrus HD-OCT in eyes of normal children.

Age groups Total (n = 276) 4–7 years (n = 76) 8–12 years (n = 145) 13–17 years (n = 55)
Percentile Percentile Percentile Percentile

GCIPL Analysis Mean 1st 5th 95th Mean 1st 5th 95th Mean 1st 5th 95th Mean 1st 5th 95th

Average (lm) 84.7 71.8 75.0 94.0 85.5 72.0 75.4 95.5 84.5 72.3 75.0 94.3 84.4 71.5 74.6 93.2
Minimun (lm) 81.2 66.2 70.4 91.0 80.7 63.0 68.2 73.9 81.2 67.7 71.1 91.7 81.6 69.5 70.9 90.4
Supero-Temporal (lm) 83.9 70.0 74.0 94.1 84.8 73.0 73.9 95.7 83.5 69.7 74.0 93.0 83.4 71.5 73.6 95.3
Superior (lm) 85.9 70.7 74.8 97.0 87.0 71.0 74.0 97.5 85.5 69.4 74.6 97.0 85.3 71.5 74.6 94.8
Supero-Nasal (lm) 86.5 72.8 76.0 96.5 87.7 75.0 77.8 96.5 86.0 72.7 75.6 96.7 86.0 72.5 74.8 98.1
lnfero-Nasal (lm) 84.7 68.2 74.9 95.0 85.0 60.0 72.9 95.1 84.6 72.4 75.6 95.8 84.0 72.0 74.6 95.2
Inferior (lm) 83.0 68.5 72.0 94.0 83.5 65.0 70.7 94.5 82.8 68.7 74.5 93.8 82.7 70.0 71.7 92.8
lnfero-Temporal (lm) 84.3 71.3 74.4 94.5 84.9 72.0 74.0 97.0 84.1 70.6 75.5 94.0 84.1 71.0 74.2 93.3

described elsewhere (Barrio-Barrio
et al. 2013). All caregivers provided
written informed consent before study
enrolment. To compile the database,
each child underwent five axial length
measurements (IOL Master, Carl Zeiss
Meditec), a cycloplegic refraction and
two macular scans using the ganglion
cell analysis: macular cube 512 9 518
protocol with the Cirrus SD-OCT.
With this protocol, the average, mini-
mum and sectoral thicknesses of the
GCIPL are measured in an elliptical
annulus around the fovea. Detailed
description of sectors dimensions and
magnification correction is described
elsewhere (Mwanza et al. 2011).
Images with signal strength <7 and
those with visible eye motion or blink-
ing artefacts were discarded. One eye
of each subject was selected randomly
for analysis. The average of the two
macular scans was used in the statisti-
cal analysis. Univariate and multivar-
iate regression analyses were used to
analyse the effects of age, gender, axial
length and spherical equivalent on the
macular GCIPL thickness measure-
ments.
Two hundred and seventy-six chil-
dren were finally included in this
study. The mean  SD age was
9.6  3.13 years, and 114 (41.3%)
were boys. The mean spherical equiv-
alent was +0.62  1.68 dioptres (D),
and mean axial length was 22.95 
1.10 mm. The mean average macular
GCIPL was 84.76  5.46 lm (range,
71–98), whereas the minimum thick-
ness was 81.20  5.95 lm (range, 63–95).
Table 1 shows the mean and percen-
tiles of GCIPL thickness values,
and each macular sector stratified by
age groups. In the multivariate regres-
sion analysis, a positive significant
association between the average GCIPL
thickness and both the spherical equiv-
alent (b = 0.75; CI 95%: 0.24–1.27,
p = 0.004) and age (b = 0.26; CI 95%
0.02–0.49, p = 0.032) was found. A
negative significant association between
the GCIPL thickness and axial length
was found (b = 0.97; CI 95%:
1.87– 0.07, p = 0.034). No significant
association with sex was found.
The mean GCIPL thickness mea-
sured by Cirrus SD-OCT and reported
in adults has been similar even among
different ethnicities: 82.1  6.2 lm
(Mwanza et al. 2011) and 82.78 
7.0 lm (Koh et al. 2012). On the con-
trary, the children in our series had a
thicker mean GCIPL thickness
(84.76 lm  5.46 lm). Remarkably,
in these three studies, of the six mac-
ular sectors, the superonasal had the
thickest, whereas the inferior had the
thinnest GCIPL. The GCIPL thickness
analysed with the Heidelberg Spectralis
SD-OCT in children using manual
segmentation at 2 mm from the foveal
centre was 84.6 lm nasally and
79.7 lm temporally (Yanni et al.
2013).
In adults, the independent factors
associated with thinner GCIPL include
thinner RNFL, older age, longer ocular
axial length and male sex (or female in
other series) (Mwanza et al. 2011; Koh
et al. 2012). On the other hand, in the
children of the present study, thinner
GCIPL was associated with younger
age, longer axial length and lower
spherical equivalent.
In summary, we have reported nor-
mative reference range of the macular
GCIPL thickness in normal children.
The effects of age, axial length and
spherical equivalent should be taken
into account when interpreting GCIPL
thickness measurements with SD-OCT
in children.
References
Barrio-Barrio J, Noval S, Galdos M et al.
(2013): Multicenter Spanish study of spec-
tral-domain optical coherence tomography
in normal children. Acta Ophthalmol 91:
56–63.
Koh VT, Tham Y-C, Cheung CY et al.
(2012): Determinants of ganglion cell-inner
plexiform layer thickness measured by
high-definition optical coherence tomogra-
phy. Invest Ophthalmol Vis Sci 53:
5853–5859.
Mwanza JC, Durbin MK, Budenz DL et al.
(2011): Profile and predictors of normal
ganglion cell-inner plexiform layer thickness
measured with frequency-domain optical
coherence tomography. Invest Ophthalmol
Vis Sci 52: 7872–7879.
Renard JP, F
enolland JR, El Chehab H et al.
(2013): Analysis of macular ganglion cell
complex (GCC) with spectral-domain
optical coherence tomography (SD-OCT)
in glaucoma. J Fr Ophtalmol 36:
299–309.
Syc SB, Saidha S, Newsome SD et al. (2012):
Optical coherence tomography segmenta-
tion reveals ganglion cell layer pathology
after optic neuritis. Brain 135: 521–533.
Yanni SE, Wang J, Cheng CS et al. (2013):
Normative Reference Ranges for the Retinal
Nerve Fiber Layer, Macula, and Retinal
Layer Thicknesses in Children. Am J Oph-
thalmol 155: 354–360.
Correspondence:
Marta Galdos, MD, PhD
Department of Ophthalmology
Cruces University Hospital
Vizcaya, Spain
Tel: + 34 629957166
Fax: + 34 944733536
Email: marta.gal2@gmail.com

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