Green A J, Cree B A C
Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
J Neurol Neurosurg Psychiatry. 2009 Sep;80(9):1002-5. doi: 10.1136/jnnp.2008.166207. Epub 2009 May 21.
This is a cross sectional study comparing the retinal features of optic neuritis (ON) between 20 multiple sclerosis (MS) and 16 neuromyelitis optica (NMO) patients with a history of ON (visual acuity at time of attack >20/100) matched for age and gender using optical coherence tomography (OCT) and fundoscopy.
Compared with MS, NMO patients often had: (1) vascular changes, including attenuation of the peripapillary vascular tree (3/40 MS eyes, 22/32 NMO eyes; p = 0.001) and focal arteriolar narrowing (0/40 MS eyes and 9/32 NMO eyes; p<0.0001), (2) a lower average nerve fibre layer (NFL) thickness (59.2 microm compared with 82.0 microm in MS; p = 0.004) and (3) nearly twice the NFL thinning after controlling for final visual acuity (32.1 vs 17.6 microm; p = 0.004). Patients with NMO had more severe and diffuse axonal injury of the NFL compared with MS.
These NFL and fundoscopic findings suggest that some of the injury seen in NMO may be vascularly mediated. These inner retinal vascular changes are reminiscent of blood vessel wall thickening previously reported in the optic nerve and spinal cord at autopsy. If the retinal changes share a common pathology to those in the spinal cord and optic nerve, these observations suggest that vascular changes may be detectable during life.
这是一项横断面研究，使用光学相干断层扫描（OCT）和检眼镜检查，比较20例多发性硬化（MS）患者和16例视神经脊髓炎（NMO）患者（均有视神经炎病史，发作时视力>20/100）的视网膜特征，两组患者在年龄和性别上相匹配。
与MS患者相比，NMO患者常有：（1）血管变化，包括视乳头周围血管树变细（MS组40只眼中有3只，NMO组32只眼中有22只；p = 0.001）和局灶性小动脉狭窄（MS组40只眼中无，NMO组32只眼中有9只；p<0.0001）；（2）平均神经纤维层（NFL）厚度较低（MS组为82.0微米，NMO组为59.2微米；p = 0.004）；（3）在控制最终视力后，NFL变薄程度几乎是MS组的两倍（分别为32.1微米和17.6微米；p = 0.004）。与MS患者相比，NMO患者的NFL轴突损伤更严重且更弥漫。
这些NFL和检眼镜检查结果表明，NMO中所见的一些损伤可能是由血管介导的。这些视网膜内层血管变化让人联想到先前尸检时在视神经和脊髓中报道的血管壁增厚。如果视网膜变化与脊髓和视神经中的变化具有共同的病理学特征，那么这些观察结果表明血管变化在生前可能是可检测到的。
