Sepulcre Jorge, Murie-Fernandez Manuel, Salinas-Alaman Angel, García-Layana Alfredo, Bejarano Bartolome, Villoslada Pablo
Department of Neurology and Neurosurgery, University of Navarra, Pamplona, Spain.
Neurology. 2007 May 1;68(18):1488-94. doi: 10.1212/01.wnl.0000260612.51849.ed.
To assess the association between the thickness of the retinal nerve fiber layer (RNFL), assessed by optical coherence tomography (OCT), retinal periphlebitis (RP), and multiple sclerosis (MS) disease activity.
We studied a prospective cohort of 61 patients and 29 matched controls for 2 years, performing a neurologic assessment every 3 months and an ophthalmologic evaluation, including OCT scans, every 6 months. Baseline MRI studies were also carried out from which brain volume and lesion load were assessed.
We found that the RNFL thickness in patients with MS was thinner than in controls, particularly in the temporal quadrant (p = 0.004). Although RNFL atrophy was greater in patients who also had optic neuritis (p = 0.002), it also augmented in MS patients who did not have optic neuritis compared with controls (p = 0.014). RNFL atrophy was correlated with greater disability (r = -0.348, p = 0.001) and longer disease duration (r = -0.301, p = 0.003). Furthermore, baseline temporal quadrant RNFL atrophy was associated with the presence of new relapses and changes in the Expanded Disability Status Scale by the end of the study (p < 0.05 in all cases). Indeed, RNFL thickness was correlated with white matter volume (r = 0.291, p = 0.005) and gray matter volume (r = 0.239, p = 0.021). The presence of RP was a risk factor for having new relapses in the next 2 years (odds ratio = 1.52, p = 0.02), and patients with RP had larger gadolinium-enhancing lesions volume (p = 0.003).
Retinal nerve fiber layer atrophy and the presence of retinal periphlebitis are associated with disease activity, suggesting that retinal evaluation can be used as biomarkers of multiple sclerosis activity.
通过光学相干断层扫描（OCT）评估视网膜神经纤维层（RNFL）厚度、视网膜静脉周围炎（RP）与多发性硬化（MS）疾病活动之间的关联。
我们对61例患者和29例匹配对照进行了为期2年的前瞻性队列研究，每3个月进行一次神经学评估，每6个月进行一次眼科评估，包括OCT扫描。还进行了基线MRI研究，评估脑容量和病变负荷。
我们发现，MS患者的RNFL厚度比对照组薄，尤其是在颞侧象限（p = 0.004）。虽然患有视神经炎的患者RNFL萎缩更严重（p = 0.002），但与对照组相比，没有视神经炎的MS患者的RNFL萎缩也有所增加（p = 0.014）。RNFL萎缩与更严重的残疾（r = -0.348，p = 0.001）和更长的病程（r = -0.301，p = 0.003）相关。此外，基线颞侧象限RNFL萎缩与研究结束时新复发的出现以及扩展残疾状态量表的变化相关（所有病例p < 0.05）。事实上，RNFL厚度与白质体积（r = 0.291，p = 0.005）和灰质体积（r = 0.239，p = 0.021）相关。RP的存在是未来2年发生新复发的危险因素（比值比 = 1.52，p = 0.02），患有RP的患者钆增强病变体积更大（p = 0.003）。
视网膜神经纤维层萎缩和视网膜静脉周围炎的存在与疾病活动相关，提示视网膜评估可作为多发性硬化活动的生物标志物。
