Reduced macular inner retinal thickness and microvascular density in the early stage of patients with dysthyroid optic neuropathy

Yufei Wu,Yunhai Tu,Chaoming Wu,Fan Lu,Jianhua Wang,Qi Chen,Meixiao Shen,Lulu Bao

doi:10.1186/s40662-020-00180-9

Abstract

BackgroundThe goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density (RCD) around the macula in thyroid-associated ophthalmopathy (TAO) patients with or without dysthyroid optic neuropathy (DON).MethodsForty-four TAO patients including 23 non-DON and 21 DON patients, and 38 healthy participants were enrolled. Spectral domain optical coherence tomography equipped with Angiovue was used to obtain three-dimensional retinal thickness maps and microvascular images of the superficial and deep retinal capillary layers (SRCL and DRCL, respectively) around the macula. Quantitative analyses were performed using a custom automated algorithm.ResultsThe thicknesses of the nerve fiber layer, ganglion cell layer + inner plexiform layer, and ganglion cell complex (GCC) as well as the RCDs in the SRCL and DRCL in both TAO groups were significantly decreased compared to the controls. In addition, the RCDs in DRCL of the DON group were further decreased compared to the non-DON group. GCC thickness in both TAO groups was positively correlated with the RCDs of the SRCL in the total annular zone and in the temporal, inferior, and nasal sectors. The areas under the receiver operating characteristic curves for the GCC thickness combined with the RCD were generally larger than those of each single indicator.ConclusionsThinned inner intra-retinal layers and decreased RCDs in the TAO patients without DON revealed that morphological changes might precede visual dysfunction. The composite index of the retinal structure and the microvascular density might be valuable in the diagnosing, monitoring, and intervention for early DON.

Highlights

The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density (RCD) around the macula in thyroid-associated ophthalmopathy (TAO) patients with or without dysthyroid optic neuropathy (DON)
The receiver operating characteristic (ROC) curve was calculated to evaluate the ability of the optical coherence tomography (OCT)-based inner intra-retinal layer thicknesses and OCT angiography (OCT-A)-based RCD to determine the impairment of the retinal structure and microvasculature in the clinically diagnosed DON cases
We found that the inner retinal thickness was thinner in both TAO groups compared to the controls, Table 4 ROC Curve Analysis of RCDs in the Retinal Capillary Layers and ganglion cell complex (GCC) Thickness in TAO Patients with DON

Summary

Introduction

The goal was to investigate changes of the inner intra-retinal layer thicknesses and retinal capillary density (RCD) around the macula in thyroid-associated ophthalmopathy (TAO) patients with or without dysthyroid optic neuropathy (DON). Graves’ disease is a progressive and organ specific autoimmune disease that typically affects the thyroid gland and the ocular orbit. 35–47% of patients with Graves’ disease have ophthalmic manifestations typically described as thyroid-associated ophthalmopathy (TAO) [1]. The manifestations are mild in the majority of TAO patients, 3–8% have a severe sightthreatening disease due to ocular neurological effects referred to as dysthyroid optic neuropathy (DON) [2,3,4]. Identifying early objective indicators in TAO even before the clinical diagnosis of DON will allow better monitoring, earlier intervention, and promote the development of new treatment methods

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Discussion

Conclusion