Retinal and Choriocapillary Vascular Changes in Early Stages of Multiple Sclerosis: A Prospective Study.

Daniela Montorio,Chiara Criscuolo,Giuseppe Pontillo,Antonio Carotenuto,Roberta Lanzillo,Antonio Luca Spiezia,Federico Perrotta,Gilda Cennamo,Marcello Moccia,Maria Petracca,Vincenzo Brescia Morra,Anna Lamberti

doi:10.3390/jcm10245756

Abstract

Optical Coherence Tomography Angiography (OCTA) abnormalities occur in multiple sclerosis (MS) over the course of the disease. OCTA investigations at early MS stages are lacking. We aimed to investigate vessel density in macular and papillary regions over two years after an initial demyelinating event (IDE). Vessel density was analyzed in superficial, deep, choriocapillaris and radial peripapillary plexus at baseline, and after one and two years. We also evaluated structural OCT parameter changes of the ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). We evaluated 30 eyes from 15 IDE patients (7 females, 8 males, mean age 28.4 ± 9.6 years) and 30 eyes from 15 healthy controls. After 2 years, we reported in the IDE group a reduced vessel density in the superficial capillary plexus, deep capillary plexus and radial peripapillary capillary plexus with respect to the baseline (coeff. β = −2.779, p = 0.013; coeff. β = −4.055, p = 0.018 and coeff. β = −2.687, p ≤ 0.001; respectively), while GCC and RNFL thicknesses did not change. Vessel density reduction was not associated with an expanded disability status scale (EDSS) change, relapse occurrence or magnetic resonance imaging activity. The analysis of healthy controls did not reveal any impairment in OCT and OCTA parameters over 2 years of follow-up. Retinal vascular loss occurs in patients with an IDE independently from clinical and radiological disease activity. Retinal vessel density could represent a novel early biomarker to monitor the MS pathological burden.

Highlights

Multiple sclerosis (MS) is an inflammatory, demyelinating disorder of the central nervous system with progressive neuroaxonal degeneration [1]
vessel density (VD) in the radial peripapillary capillary plexus was significantly lower in those patients with an initial demyelinating event (IDE) compared with the healthy controls
While we did not show any change in Optical Coherence Tomography Angiography (OCTA) measures in the healthy controls, in patients with an IDE we identified a decrease in VD in the superficial, deep capillary plexuses and radial peripapillary capillary plexus

Summary

Introduction

Multiple sclerosis (MS) is an inflammatory, demyelinating disorder of the central nervous system with progressive neuroaxonal degeneration [1]. The retina, showing similar anatomical and physiological features as the brain, reflects cerebral changes occurring in MS patients [2,3]. The use of optical coherence tomography (OCT) in MS studies facilitates the detection, in a non-invasive and rapid way, of the changes to neuroretinal structures, such as ganglion cell complexes (GCC) and retinal nerve fiber layers (RNFL), at different stages of this disease [4]. The OCT parameters allow investigation of MS pathophysiological mechanisms, both at early disease stages with prominent inflammatory activity and later on, as neurodegeneration advances [5]. RNFL and GCC allow for stratifying the patients for different treatment choices [6,7]. Several reports and longitudinal evaluations demonstrated a significant retinal neurodegeneration, confirmed by thinning of GCC and RNFL [8,9]

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