Progressive Loss of Retinal Ganglion Cells and Axons in Nonoptic Neuritis Eyes in Multiple Sclerosis: A Longitudinal Optical Coherence Tomography Study
Progressive Loss of Retinal Ganglion Cells and Axons in Nonoptic Neuritis Eyes in Multiple Sclerosis: A Longitudinal Optical Coherence Tomography Study
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DOI：
10.1167/iovs.15-19047
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发表时间：
2016-04-01
影响因子：
4.4
通讯作者：
Klistorner, Alexander
中科院分区：
文献类型：
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作者：
Graham, Elizabeth C.;You, Yuyi;Klistorner, Alexander
目的.目的探讨复发缓解型多发性硬化（RRMS）患者非视神经炎（NON）眼视网膜神经节细胞（RGC）层和视网膜神经纤维层（RNFL）的改变率，寻找一种可用于判断病情进展的特异性影像学指标。入组了45名连续RRMS患者和20名年龄和性别匹配的健康受试者。所有患者随访3年，每年进行一次光学相干断层扫描（OCT），其中包括用于RNFL分析的视乳头周围环形扫描方案和用于获得RGC/内丛状层（IPL）厚度测量的黄斑放射状星状扫描。健康对照组扫描两次，间隔3年。视网膜神经节细胞/内丛状层和颞侧RNFL（tRNFL）与正常对照组相比显著变薄（P < 0.01），而鼻段和全侧RNFL（gRNFL）与正常对照组相比无显著性差异。虽然受试者工作特征（ROC）分析显示，在变薄的横截面检测中，RGC/IPL与tRNFL相比没有优势，但健康对照组中基于第五百分位数的截断点显示RGC/IPL的异常率较高。在随访期间，RGC/IPL和tRNFL显著进行性丢失。在tRNFL中观察到最大的厚度减少。ROC分析表明，tRNFL比RGC/IPL提供了更好的检测随时间变化的灵敏度/特异性（曲线下面积[AUC] 0.78 vs. 0.52），这通过使用健康对照中进展的第95百分位数作为截止值时更高的检测率得到证实。该研究证实了RRMS患者的非ON眼中RGC/IPL和tRNFL显著变薄。tRNFL的进行性丢失更明显，而RGC/IPL在随访期间的变化较小。
PURPOSE. To examine the rate of retinal ganglion cell (RGC) layer and retinal nerve fiber layer (RNFL) changes in nonoptic neuritis (NON) eyes of relapsing remitting multiple sclerosis (RRMS) patients, and to find a specific imaging parameter useful for identifying disease progression.METHODS. Forty-five consecutive RRMS patients and 20 age-and sex-matched healthy subjects were enrolled. All patients were followed up for 3 years with annual optical coherence tomography (OCT) scans, which included a peripapillary ring scan protocol for RNFL analysis and a macular radial star-like scan to obtain RGC/inner plexiform layer (IPL) thickness measures. Healthy controls were scanned twice, 3 years apart.RESULTS. Retinal ganglion cell/inner plexiform layer and temporal RNFL (tRNFL) demonstrated highly significant thinning (P < 0.01), but all nasal segments and global RNFL (gRNFL) were not significantly different from normal controls. While receiver operating characteristics (ROC) analysis showed no advantage of RGC/IPL over tRNFL in cross-sectional detection of thinning, cut-off point based of fifth percentile in healthy controls demonstrated higher rate of abnormality for RGC/IPL. There was a significant progressive loss of RGC/IPL and tRNFL during the follow-up period. The largest thickness reduction was observed in tRNFL. ROC analysis demonstrated that tRNFL provided better sensitivity/specificity for detecting change over time than RGC/IPL (area under the curve [AUC] 0.78 vs. 0.52), which was confirmed by higher detection rate when 95th percentile of progression in healthy controls was used as a cut-off.CONCLUSIONS. This study confirmed significant thinning of RGC/IPL and tRNFL in NON eyes of RRMS patients. Progressive losses were more apparent on tRNFL, while RGC/IPL showed less change over the follow-up period.