Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2012 Jun;119(6):1250-7. doi: 10.1016/j.ophtha.2011.11.032. Epub 2012 Feb 23.
We used high-resolution spectral-domain optical coherence tomography (SD-OCT) with retinal segmentation to determine how ganglion cell loss relates to history of acute optic neuritis (ON), retinal nerve fiber layer (RNFL) thinning, visual function, and vision-related quality of life (QOL) in multiple sclerosis (MS).
Cross-sectional study.
A convenience sample of patients with MS (n = 122; 239 eyes) and disease-free controls (n = 31; 61 eyes). Among MS eyes, 87 had a history of ON before enrollment.
The SD-OCT images were captured using Macular Cube (200×200 or 512×128) and ONH Cube 200×200 protocols. Retinal layer segmentation was performed using algorithms established for glaucoma studies. Thicknesses of the ganglion cell layer/inner plexiform layer (GCL+IPL), RNFL, outer plexiform/inner nuclear layers (OPL+INL), and outer nuclear/photoreceptor layers (ONL+PRL) were measured and compared in MS versus control eyes and MS ON versus non-ON eyes. The relation between changes in macular thickness and visual disability was also examined.
The OCT measurements of GCL+IPL and RNFL thickness; high contrast visual acuity (VA); low-contrast letter acuity (LCLA) at 2.5% and 1.25% contrast; on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement composite score.
Macular RNFL and GCL+IPL were significantly decreased in MS versus control eyes (P<0.001 and P = 0.001) and in MS ON versus non-ON eyes (P<0.001 for both measures). Peripapillary RNFL, macular RNFL, GCL+IPL, and the combination of macular RNFL+GCL+IPL were significantly correlated with VA (P≤0.001), 2.5% LCLA (P<0.001), and 1.25% LCLA (P≤0.001). Among OCT measurements, reductions in GCL+IPL (P<0.001), macular RNFL (P = 0.006), and the combination (macular RNFL+GCL+IPL; P<0.001) were most strongly associated with lower (worse) NEI-VFQ-25 and 10-Item Supplement QOL scores; GCL+IPL thinning was significant even accounting for macular RNFL thickness (P = 0.03 for GCL+IPL, P = 0.39 for macular RNFL).
We demonstrated that GCL+IPL thinning is most significantly correlated with both visual function and vision-specific QOL in MS, and may serve as a useful structural marker of disease. Our findings parallel those of magnetic resonance imaging studies that show gray matter disease is a marker of neurologic disability in MS.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
我们使用高分辨率谱域光相干断层扫描（SD-OCT）结合视网膜分层技术，以确定在多发性硬化症（MS）中，神经节细胞丢失与急性视神经炎（ON）病史、视网膜神经纤维层（RNFL）变薄、视觉功能和与视觉相关的生活质量（QOL）之间的关系。
横断面研究。
MS 患者的便利样本（n=122；239 只眼）和无疾病对照组（n=31；61 只眼）。在 MS 眼中，87 只眼在入组前有 ON 病史。
使用 Macular Cube（200×200 或 512×128）和 ONH Cube 200×200 方案采集 SD-OCT 图像。使用为青光眼研究建立的算法进行视网膜层分割。测量并比较 MS 与对照组眼以及 MS ON 与非 ON 眼的神经节细胞层/内丛状层（GCL+IPL）、RNFL、外丛状/内核层（OPL+INL）和外核/光感受器层（ONL+PRL）的厚度。还检查了黄斑厚度变化与视觉障碍之间的关系。
GCL+IPL 和 RNFL 厚度的 OCT 测量；高对比度视力（VA）；2.5%和 1.25%对比度的低对比度字母视力（LCLA）；25 项国家眼科研究所视觉功能问卷（NEI-VFQ-25）和 10 项神经眼科补充综合评分。
MS 与对照组眼相比（P<0.001 和 P=0.001）以及 MS ON 与非 ON 眼相比（两者均 P<0.001），黄斑 RNFL 和 GCL+IPL 明显变薄。视盘周围 RNFL、黄斑 RNFL、GCL+IPL 和黄斑 RNFL+GCL+IPL 组合均与 VA（P≤0.001）、2.5% LCLA（P<0.001）和 1.25% LCLA（P≤0.001）显著相关。在 OCT 测量中，GCL+IPL 减少（P<0.001）、黄斑 RNFL 减少（P=0.006）和组合（黄斑 RNFL+GCL+IPL；P<0.001）与较低（较差）的 NEI-VFQ-25 和 10 项补充 QOL 评分最密切相关；即使考虑到黄斑 RNFL 厚度，GCL+IPL 变薄也具有显著意义（GCL+IPL 为 P=0.03，黄斑 RNFL 为 P=0.39）。
我们证明 GCL+IPL 变薄与 MS 中的视觉功能和特定于视觉的 QOL 最密切相关，并且可能是疾病的有用结构标志物。我们的发现与磁共振成像研究一致，该研究表明灰质疾病是 MS 中神经功能障碍的标志物。
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