Microcystic macular oedema, thickness of the inner nuclear layer of the retina, and disease characteristics in multiple sclerosis: a retrospective study.
Microcystic macular oedema, thickness of the inner nuclear layer of the retina, and disease characteristics in multiple sclerosis: a retrospective study.
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DOI：
10.1016/s1474-4422(12)70213-2
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发表时间：
2012-11
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通讯作者：
Calabresi PA
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作者：
Saidha S;Sotirchos ES;Ibrahim MA;Crainiceanu CM;Gelfand JM;Sepah YJ;Ratchford JN;Oh J;Seigo MA;Newsome SD;Balcer LJ;Frohman EM;Green AJ;Nguyen QD;Calabresi PA
视网膜内核层（INL）的微囊性黄斑水肿（MME）最近已被确定在多发性硬化症（MS）患者的光学相干断层扫描（OCT）。我们旨在确定INL的MME和/或INL的更高厚度是否与疾病活动或残疾进展相关。本回顾性研究在约翰霍普金斯医院进行（2008年9月至2012年3月）。164名MS患者和60名健康对照者进行了连续OCT扫描和临床评价（包括视觉功能）。OCT扫描，包括自动视网膜内层分割，得出视网膜神经纤维层、神经节细胞层（加上内丛状层）、INL（加上外丛状层）和外核层的厚度。MS患者还接受了每年一次的脑部MRI扫描。残疾评分采用Wilcoxon秩和检验进行比较。混合效应线性回归用于比较OCT测量和字母视力评分。使用逻辑回归来检查基线OCT厚度与临床放射学参数的关系。MS患者和健康对照组的平均随访时间（标准差）分别为25.8个月（9.1个月）和22.4个月（11.4个月）。10例MS患者（队列的6.1%）在至少一次研究访视期间显示MME，但其中6例患者在基线时未观察到MME。在研究期间的任何时间，有与无MME的MS患者（151名MS患者）的基线多发性硬化严重程度评分较高（p= 0.032），尽管扩展残疾状态量表（EDSS）评分无显著差异（p= 0.097）。基线时，有MME的MS眼（12眼）与无MME的MS眼（302眼）相比，字母视敏度评分较低（100%对比度：p =0·017; 2·5%对比度：p=0·031; 1·25%对比度：p=0·014），INL厚度较高（p=0·003）。MS患者的基线INL厚度较高可预测研究期间造影剂增强病变（p= 0.007）、新T2病变（p= 0.015）、EDSS进展（p= 0.034）和复发（复发缓解型MS; p= 0.008）的发生。MME与随访期间的疾病活动无关。健康对照组未表现出MME。OCT上INL厚度增加，可能代表无髓视网膜的炎症，与MS中的疾病活动相关。如果这一发现得到证实，INL厚度可能是MS中疾病进展的有用预测因子。（TR 3760-A-3，RG 4212-A-4），国家眼科研究所（R 01-EY 014993，R 01-EY 019473），布拉克斯顿黛比安吉拉狄龙和跳过捐赠基金。
Microcystic macular edema (MME) of the retinal inner nuclear layer (INL) has recently been identified in multiple sclerosis (MS) patients with optical coherence tomography (OCT). We aimed to determine if MME of the INL, and/or higher thickness of the INL, are associated with disease activity, or disability progression. This retrospective study was performed at Johns Hopkins Hospital (between 09/2008 and 03/2012). 164 MS patients and 60 healthy-controls underwent serial OCT scans and clinical evaluation (including visual function). OCT scanning, including automated intra-retinal layer segmentation, yielded thicknesses of the retinal nerve fiber layer, ganglion cell layer (plus inner plexiform layer), INL (plus outer plexiform layer), and outer nuclear layer. MS patients also underwent annual brain MRI scans. Disability scores were compared with the Wilcoxon rank-sum test. Mixed-effects linear regression was used to compare OCT measures and letter-acuity scores. Logistic regression was used to examine the relationships of baseline OCT thicknesses with clinico-radiological parameters. Mean follow-up (standard deviation) for MS patients and healthy-controls was 25·8-months (9·1-months) and 22·4-months (11·4-months) respectively. 10 MS patients (6·1% of the cohort) demonstrated MME during at least one study visit, but MME was not visible at baseline in 6 of these patients. MS patients with vs. without MME (151 MS patients) at any time during the study had higher baseline multiple sclerosis severity scores (p=0·032), although expanded disability status scale (EDSS) scores were not significantly different (p=0·097). MS eyes with MME (12 eyes) vs. without MME (302 eyes) had lower letter-acuity scores (100%-contrast: p=0·017; 2·5%-contrast: p=0·031; 1·25%-contrast: p=0·014), and higher INL thicknesses (p=0·003) at baseline. Higher baseline INL thickness in MS predicted the development of contrast-enhancing lesions (p=0·007), new T2 lesions (p=0·015), EDSS progression (p=0·034), and relapses (in relapsing-remitting MS; p=0·008) during the study. MME was not associated with disease activity during follow-up. Healthy-controls did not demonstrate MME. Increased INL thickness on OCT, potentially representing inflammation of the unmyelinated retina, is associated with disease activity in MS. If this finding is confirmed, INL thickness may be a useful predictor of disease progression in MS. National Multiple Sclerosis Society (TR3760-A-3, RG4212-A-4), National Eye Institute (R01-EY014993, R01-EY019473), Braxton Debbie Angela Dillon and Skip Donor Fund.