You Yuyi, Graham Elizabeth C, Shen Ting, Yiannikas Con, Parratt John, Gupta Vivek, Barton Joshua, Dwyer Michael, Barnett Michael H, Fraser Clare L, Graham Stuart L, Klistorner Alexander
Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY.
Neurol Neuroimmunol Neuroinflamm. 2017 Dec 15;5(1):e427. doi: 10.1212/NXI.0000000000000427. eCollection 2018 Jan.
To investigate primary retinal functional changes in non-optic neuritis (ON) eyes of patients with MS by full-field electroretinography (ERG).
Seventy-seven patients with relapsing-remitting MS with no history of clinical ON in at least 1 eye and 30 healthy controls were recruited in the cohort study. Full-field ERGs were recorded, and retinal optical coherence tomography scans were performed to assess the thicknesses of peripapillary retinal nerve fiber layer (RNFL) and retinal ganglion cell layer-inner plexiform layer (GCL-IPL). Annual MRI scans were also carried out to evaluate the disease activity in the brain. Patients were followed up for 3 years.
At baseline, a delayed b-wave peak time was observed in the cone response ( < 0.001), which was associated with the thicknesses of RNFL and GCL-IPL. The peak time of the delayed b-wave also correlated with the Expanded Disability Status Scale, T2 lesion volume, and disease duration. During the 3-year follow-up, progressive ERG amplitude reduction was observed (both a- and b-waves, < 0.05). There was a correlation between the b-wave amplitude reduction and longitudinal RNFL loss ( = 0.001). However, no correlation was found between longitudinal ERG changes and disease activity in the brain.
This study demonstrated progressive inner nuclear layer dysfunction in MS. The borderline a-wave changes suggested some outer retinal dysfunction as well. The correlation between full-field ERG changes and retinal ganglion cell loss suggested that there might be subclinical retinal pathology in MS affecting both outer and inner retinal layers.
通过全视野视网膜电图（ERG）研究多发性硬化症（MS）患者非视神经炎（ON）眼的原发性视网膜功能变化。
在队列研究中招募了77例复发缓解型MS患者，这些患者至少一只眼无临床ON病史，以及30名健康对照者。记录全视野ERG，并进行视网膜光学相干断层扫描以评估视乳头周围视网膜神经纤维层（RNFL）和视网膜神经节细胞层-内丛状层（GCL-IPL）的厚度。还进行年度MRI扫描以评估脑部疾病活动。对患者进行了3年的随访。
在基线时，在视锥细胞反应中观察到b波峰时间延迟（<0.001），这与RNFL和GCL-IPL的厚度相关。延迟b波的峰时间也与扩展残疾状态量表、T2病变体积和病程相关。在3年随访期间，观察到ERG振幅逐渐降低（a波和b波，均<0.05）。b波振幅降低与纵向RNFL损失之间存在相关性（=0.001）。然而，未发现纵向ERG变化与脑部疾病活动之间存在相关性。
本研究证明了MS患者存在进行性内核层功能障碍。临界a波变化也提示存在一些外层视网膜功能障碍。全视野ERG变化与视网膜神经节细胞丢失之间的相关性表明，MS可能存在亚临床视网膜病变，影响外层和内层视网膜。
