Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (Instituto de Investigación Sanitario [IIS] Aragon), University of Zaragoza, Zaragoza, Spain.
Aragon Institute for Health Research (Instituto de Investigación Sanitario [IIS] Aragon), University of Zaragoza, Zaragoza, Spain; Department of Neurology, Miguel Servet University Hospital, Zaragoza, Spain.
Ophthalmology. 2017 May;124(5):688-696. doi: 10.1016/j.ophtha.2017.01.005. Epub 2017 Feb 7.
To quantify retinal nerve fiber layer (RNFL) changes in patients with multiple sclerosis (MS) and healthy controls with a 5-year follow-up and to analyze correlations between disability progression and RNFL degeneration.
Observational and longitudinal study.
One hundred patients with relapsing-remitting MS and 50 healthy controls.
All participants underwent a complete ophthalmic and electrophysiologic exploration and were re-evaluated annually for 5 years.
Visual acuity (Snellen chart), color vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (SLP), and visual evoked potentials. Expanded Disability Status Scale (EDSS) scores, disease duration, treatments, prior optic neuritis episodes, and quality of life (QOL; based on the 54-item Multiple Sclerosis Quality of Life Scale score).
Optical coherence tomography (OCT) revealed changes in all RNFL thicknesses in both groups. In the MS group, changes were detected in average thickness and in the mean deviation using the GDx-VCC nerve fiber analyzer (Laser Diagnostic Technologies, San Diego, CA) and in the P100 latency of visual evoked potentials; no changes were detected in visual acuity, color vision, or visual fields. Optical coherence tomography showed greater differences in the inferior and temporal RNFL thicknesses in both groups. In MS patients only, OCT revealed a moderate correlation between the increase in EDSS and temporal and superior RNFL thinning. Temporal RNFL thinning based on OCT results was correlated moderately with decreased QOL.
Multiple sclerosis patients exhibit a progressive axonal loss in the optic nerve fiber layer. Retinal nerve fiber layer thinning based on OCT results is a useful marker for assessing MS progression and correlates with increased disability and reduced QOL.
通过 5 年随访，量化多发性硬化症 (MS) 患者和健康对照者的视网膜神经纤维层 (RNFL) 变化，并分析残疾进展与 RNFL 退化之间的相关性。
观察性和纵向研究。
100 例复发缓解型 MS 患者和 50 例健康对照者。
所有参与者均接受全面的眼科和电生理检查，并在 5 年内每年进行一次评估。
视力（Snellen 图表）、色觉（Ishihara 假同色板）、视野检查、光学相干断层扫描（OCT）、扫描激光偏振仪（SLP）和视觉诱发电位。扩展残疾状况量表（EDSS）评分、疾病持续时间、治疗、既往视神经炎发作和生活质量（基于 54 项多发性硬化症生活质量量表评分）。
OCT 显示两组所有 RNFL 厚度均有变化。在 MS 组中，使用 GDx-VCC 神经纤维分析仪（激光诊断技术，圣地亚哥，加利福尼亚州）检测到平均厚度和平均偏差以及视觉诱发电位 P100 潜伏期的变化；视力、色觉或视野均无变化。OCT 显示两组下和颞侧 RNFL 厚度差异更大。仅在 MS 患者中，OCT 显示 EDSS 增加与颞侧和上方 RNFL 变薄之间存在中度相关性。OCT 结果显示颞侧 RNFL 变薄与生活质量下降中度相关。
多发性硬化症患者的视神经纤维层存在进行性轴索丧失。OCT 结果显示的 RNFL 变薄是评估 MS 进展的有用标志物，与残疾加重和生活质量下降相关。
