Dachsel R M, Dachsel R, Domke S, Groß T, Schubert O, Kotrini L, Ladegast K, Vogel J, Jordan T, Zawade S
East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, Redhill, UK,
Nervenarzt. 2015 Feb;86(2):187-96. doi: 10.1007/s00115-014-4241-1.
This study evaluated whether progressive optic neuropathy (ON) is commonly found after retrobulbar neuritis and whether optical coherence tomography (OCT) is a useful tool for follow-up of patients with multiple sclerosis (MS).
An observational study of 86 MS patients (currently treated with immunomodulation) with a past medical history of ON was carried out. Patients were assessed in 2010 and 2012 using the expanded disability status scale (EDSS), visual acuity, visual evoked potentials (VEP) and OCT but magnetic resonance imaging (MRI) was performed only in 2012.
In this study 16 men and 70 women with a mean age of 41.6 and 43.8 years, respectively, were evaluated (28 patients post bilateral and 58 patients post unilateral ON including 114 eyes post-ON and 58 eyes without previous ON). Visual acuity and VEPs improved or remained the same over the study period. Visual acuity, VEPs, retinal nerve fiber layer (RNFL) thickness and macular volume were significantly worse in eyes post-ON compared to eyes without previous ON. The RNFL significantly decreased over the study period in eyes post-ON from an average of 79.9 ± 13.3 μm to 77.0 ± 12.9 μm (p < 0.0001) and eyes without previous ON from 89.5 ± 12.9 μm to 86.0 ± 12.5 μm (p < 0.0001). The number of VEPs and RNFL thickness were significantly correlated with visual acuity in all eyes. In patients after unilateral ON the brain atrophy parameters corpus callosum index (CCI) and cella media index (CMI) were negatively correlated with the EDSS.
Initially MS often begins with an episode of ON which can be stabilized by immunomodulation. A mild progressive ON was generally detectable in this study but severe progressive ON was rarely observed. The OCT measurements showed no better correlation than the VEPs with visual acuity; however, OCT can be applied for confirmation of atypical ON. The corpus callosum index seems to be best associated with the degree of disability while, as already described in the literature, the number of T2 lesions is not well correlated with disability, probably due to the small-world network function of the brain and the position of the lesions in areas with no clinical relevance.
本研究评估了球后视神经炎后是否常见进行性视神经病变（ON），以及光学相干断层扫描（OCT）是否是多发性硬化症（MS）患者随访的有用工具。
对86例有ON病史（目前接受免疫调节治疗）的MS患者进行了一项观察性研究。在2010年和2012年使用扩展残疾状态量表（EDSS）、视力、视觉诱发电位（VEP）和OCT对患者进行评估，但仅在2012年进行了磁共振成像（MRI）检查。
本研究评估了16名男性和70名女性，平均年龄分别为41.6岁和43.8岁（28例双侧ON后患者和58例单侧ON后患者，包括114只ON后眼睛和58只既往无ON的眼睛）。在研究期间，视力和VEP改善或保持不变。与既往无ON的眼睛相比，ON后眼睛的视力、VEP、视网膜神经纤维层（RNFL）厚度和黄斑体积明显更差。在研究期间，ON后眼睛的RNFL从平均79.9±13.3μm显著下降至77.0±12.9μm（p<0.0001），既往无ON的眼睛从89.5±12.9μm下降至86.0±12.5μm（p<0.0001）。所有眼睛的VEP数量和RNFL厚度与视力显著相关。在单侧ON后的患者中，脑萎缩参数胼胝体指数（CCI）和中脑指数（CMI）与EDSS呈负相关。
最初，MS通常始于一次ON发作，可通过免疫调节使其稳定。在本研究中通常可检测到轻度进行性ON，但很少观察到严重进行性ON。OCT测量显示与视力的相关性并不比VEP更好；然而，OCT可用于确认非典型ON。胼胝体指数似乎与残疾程度最相关，而正如文献中已经描述的，T2病变的数量与残疾程度相关性不佳，这可能是由于大脑的小世界网络功能以及病变位于无临床相关性的区域。
