Abstract
BackgroundMicrocystic macular edema (MME) and inner nuclear layer thickening (INL) were described in multiple sclerosis (MS) and neuromyelitis optica (NMO) patients using optical coherence tomography (OCT). The cause of these findings is currently unknown and a relation to inflammatory or degenerative processes in the optic nerve is discussed.ObjectiveThe aim of our study was to investigate whether INL thickening and MME are related to optic neuritis (ON) in various neuro-inflammatory disorders causingON: MS, NMO and chronic inflammatory optic neuropathy.MethodsWe retrospectively analyzed data from 216 MS patients, 39 patients with a clinically isolated syndrome, 20 NMO spectrum disorder patients, 9 patients with chronic inflammatory optic neuropathy and 121 healthy subjects. Intra-retinal layer segmentation was performed for the eyes of patients with unilateral ON. Scanning laser ophthalmoscopy (SLO) images were reviewed for characteristic ocular fundus changes.ResultsIntra-retinal layer segmentation showed that eyes with a history of ON displayed MME independent INL thickening compared to contralateral eyes without previous ON. MME was detected in 22 eyes from 15 patients (5.3% of all screened patients), including 7 patients with bilateral edema. Of these, 21 had a prior history of ON (95%). The SLO images of all 22 MME-affected eyes showed crescent-shaped texture changes which were visible in the perifoveal region. A second grader who was blinded to the results of the OCT classified all SLO images for the presence of these characteristic fundus changes. All MME eyes were correctly classified (sensitivity = 100%) with high specificity (95.2%).ConclusionThis study shows that both MME and INL thickening occur in various neuro-inflammatory disorders associated with ON. We also demonstrate that detection and analysis of MME by OCT is not limited to B-scans, but also possible using SLO images.
Highlights
Optic neuritis (ON) is a common symptom of inflammatory central nervous system disorders that often heralds a diagnosis of multiple sclerosis (MS) or neuromyelitis optica (NMO) [1,2,3,4,5]
This study shows that both Microcystic macular edema (MME) and inner nuclear layer thickening (INL) thickening occur in various neuro-inflammatory disorders associated with ON
We demonstrate that detection and analysis of MME by optical coherence tomography (OCT) is not limited to B-scans, and possible using Scanning laser ophthalmoscopy (SLO) images
Summary
Optic neuritis (ON) is a common symptom of inflammatory central nervous system disorders that often heralds a diagnosis of multiple sclerosis (MS) or neuromyelitis optica (NMO) [1,2,3,4,5] In both diseases, ON can cause irreversible damage to axons in the retina and their neurons, the retinal ganglion cells, which can be quantified by optical coherence tomography (OCT) [6,7,8,9,10]. Microcystic macular edema (MME) and inner nuclear layer thickening (INL) were described in multiple sclerosis (MS) and neuromyelitis optica (NMO) patients using optical coherence tomography (OCT). The cause of these findings is currently unknown and a relation to inflammatory or degenerative processes in the optic nerve is discussed
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