Abstract
Purpose: To evaluate the intermediate and outer retina of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using OCT and multifocal electroretinography (mf-ERG).Methods: Patients with MS (n = 30), NMOSD (n = 30), and healthy controls (n = 29) underwent visual field (VF), OCT, and mf-ERG testing. The eyes were distributed into 5 groups: MS with or without history of ON (MS+ON, MS–ON), NMOSD with or without ON (NMOSD+ON, NMOSD–ON), and controls. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, and photoreceptor layer was measured. mf-ERG P1 and N1 responses were registered and grouped in 3 sets of rings. The groups were compared using GEE models, and effect size (ES) calculated.Results: Compared to controls, GCL and IPL thickness was significantly smaller in MS+ON (both p < 0.01), MS–ON (p < 0.01 and p = 0.015, respectively), NMOSD+ON (both p < 0.01) and NMOSD–ON (p = 0.03 and p = 0.018, respectively). ES was >0.80. mRNFL was smaller in three of the above groups (p < 0.01, p < 0.001, and p = 0.028; ES > 0.80) but not in MS–ON eyes (p = 0.18). No significant difference was observed for the remaining layers. Compared to controls, P1 and N1 peak times were shorter in MS (p-values in the range 0.049–0.002, ES < 0.50; and 0.049–0.010; ES < 0.50, respectively) but not in NMOSD. These abnormalities were strongly correlated with intermediate and outer retinal layer thickness.Conclusions: mf-ERG data suggest outer retinal abnormalities in MS, but not in NMOSD. Our results may help understand how the two conditions differ regarding retinal damage.
Highlights
Anterior visual pathway involvement is an important clinical manifestation of both multiple sclerosis (MS) and neuromyelitis optica (NMO) [1]—two autoimmune diseases which frequently lead to optic neuritis (ON) and/or transverse myelitis [2]
A total of 30 patients (26 female) with MS and 30 (25 female) with NMO spectrum disorder (NMOSD) randomly selected from the outpatient clinic, and 29 healthy controls were included in the study
Since no eye was excluded from the study, 22 eyes were classified as MS with ON (MS+ON) and 38 as MS without ON (MS–ON)
Summary
Anterior visual pathway involvement is an important clinical manifestation of both multiple sclerosis (MS) and neuromyelitis optica (NMO) [1]—two autoimmune diseases which frequently lead to optic neuritis (ON) and/or transverse myelitis [2]. While the pathophysiology of the two conditions differ with regard to immune mechanisms, both lead to optic nerve damage and retrograde degeneration of the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) [1,2,3,4]. The classic diagnostic criteria for NMO include a history of ON and acute transverse myelitis [8], but recently the definition was expanded to include clinical signs which allow to establish a diagnosis of NMO spectrum disorder (NMOSD) using an algorithm of revised diagnostic criteria [9]. Patients with isolated ON or LETM may be diagnosed with NMOSD provided they test positive for anti-AQ4 antibody or have a specific combination of clinical and radiological findings [9, 10]
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