Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA.
Mult Scler. 2011 Dec;17(12):1449-63. doi: 10.1177/1352458511418630. Epub 2011 Aug 24.
Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS.
To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures.
Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects.
GCL+inner plexiform layer (GCIP) was thinner in relapsing-remitting MS (RRMS; n = 96, 71.6 µm), secondary progressive MS (SPMS; n = 20, 66.4 µm) and primary progressive MS (PPMS; n = 16, 74.1 µm) than in healthy controls (81.8 µm; p < 0.001 for all). GCIP thickness was most decreased in SPMS, and although GCIP thickness correlated significantly with disease duration, after adjusting for this, GCIP thickness remained significantly lower in SPMS than RRMS. GCIP thickness correlated significantly, and better than RNFL thickness, with EDSS, high-contrast, 2.5% low-contrast and 1.25% low-contrast letter acuity in MS. 13.6% of patients also demonstrated inner or outer nuclear layer thinning.
OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.
对多发性硬化症（MS）患者眼部的死后分析表明，除了相关的视网膜神经纤维层（RNFL）损失外，还存在明显的视网膜神经节细胞层（GCL）损失。尽管如此，MS 患者的视网膜神经层的临床相关性在很大程度上仍未得到探索。
确定 MS 患者是否存在活体视网膜神经节细胞 GCL 损失、更深层的视网膜神经损失，并研究视网膜层厚度与 MS 临床亚型和经过验证的临床指标之间的相关性。
对 132 名 MS 患者和 78 名健康对照者进行 Cirrus HD-OCT（利用自动视网膜内部分层分割）检查。研究对象记录了 MS 分类、扩展残疾状况量表（EDSS）和视力。
与健康对照组（81.8μm；p<0.001）相比，复发缓解型 MS（RRMS；n=96，71.6μm）、继发进展型 MS（SPMS；n=20，66.4μm）和原发进展型 MS（PPMS；n=16，74.1μm）的 GCL+内丛状层（GCIP）更薄。SPMS 的 GCIP 厚度减少最明显，尽管 GCIP 厚度与疾病持续时间显著相关，但在调整了这一因素后，SPMS 的 GCIP 厚度仍显著低于 RRMS。GCIP 厚度与 EDSS、高对比度、2.5%低对比度和 1.25%低对比度字母视力显著相关，相关性优于 RNFL 厚度。在 MS 中，13.6%的患者还表现出内或外核层变薄。
OCT 分割显示所有 MS 亚型的活体 GCIP 变薄。与 RNFL 厚度相比，GCIP 厚度在 MS 中显示出更好的结构-功能相关性（与视力和残疾相关）。除了常见的 RNFL/GCIP 变薄外，MS 还发生视网膜内和外核层变薄。
