Spectral-Domain Optical Coherence Tomography Assessment in Treatment-Naïve Patients with Clinically Isolated Syndrome and Different Multiple Sclerosis Types: Findings and Relationship with the Disability Status.

Łukasz Rzepiński,Zdzisław Maciejek,Andrzej Grzybowski,Jan Kucharczuk,Vincenzo Parisi

doi:10.3390/jcm10132892

Abstract

This study evaluates the peripapillary retinal nerve fiber layer (pRNFL) thickness and total macular volume (TMV) using spectral-domain optical coherence tomography in treatment naïve patients with the clinically isolated syndrome (CIS) and different multiple sclerosis (MS) types. A total of 126 patients (15 CIS, 65 relapsing-remitting MS, 14 secondary progressive MS, 11 primary progressive MS, 21 benign MS) with or without optic neuritis (ON) history and 63 healthy age-similar controls were assessed. Concerning controls’ eyes, pRNFL thickness was significantly reduced in CIS-ON eyes (p < 0.01), while both TMV and pRNFL thickness was decreased in all MS eyes regardless of ON history (p < 0.01). Significant differences in pRNFL thickness and TMV between MS variants were observed for non-ON eyes (p < 0.01), with the lowest values in benign and secondary progressive disease type, respectively. The pRNFL thickness was inversely correlated with Expanded Disability Status Scale (EDSS) score in non-ON subgroups (p < 0.01), whereas TMV was inversely correlated with EDSS score in both ON and non-ON subgroups (p < 0.01). Concluding, pRNFL thinning confirms optic nerve damage in CIS-ON eyes and appears to be disproportionately high with respect to the disability status of benign MS patients. The values of TMV and pRNFL in non-ON eyes significantly correspond to MS course heterogeneity and patients’ disability than in ON eyes.

Highlights

Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS) with underlying inflammatory and degenerative mechanisms
The highest Expanded Disability Status Scale (EDSS) score was found in the primary progressive MS (PPMS) group, and the highest percentage of participants with a history of optic neuritis (ON) was recorded in the secondary progressive MS (SPMS) group
The presented study confirms the varied involvement of inner retinal layers in treatment-naïve multiple sclerosis (MS) patients with different disease types only in the case of NON eyes

Summary

Introduction

Multiple sclerosis (MS) is a chronic, immune-mediated disorder of the central nervous system (CNS) with underlying inflammatory and degenerative mechanisms. The majority of MS patients (85–90%) have an initial relapsing-remitting disease course (relapsing-remitting MS - RRMS) characterized by relapses associated with the formation of new demyelinating lesions in the CNS, followed by a complete or partial recovery and stable neurological condition between attacks. Diagnosis of benign MS (BNMS) is determined retrospectively based on Expanded Disability Status Scale (EDSS) score and disease duration. MS variants differ in pathogenesis, the severity of neurodegeneration processes, and, most importantly, the rate of disability progression [11,12,13]. Magnetic resonance imaging (MRI) remains the most valuable, enabling monitoring of both inflammatory areas and brain atrophy. MRI imaging faces some limitations in monitoring subclinical aspects of the disease progression, such as normal-appearing white matter [14]

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