Al-Bahar Ophthalmology Center, Ibn Sina Hospital, Kuwait; Neurology Clinic, Dasman Institute, Dasman, Kuwait; Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait.
Al-Bahar Ophthalmology Center, Ibn Sina Hospital, Kuwait; Neurology Clinic, Dasman Institute, Dasman, Kuwait.
Mult Scler Relat Disord. 2018 Apr;21:56-62. doi: 10.1016/j.msard.2018.02.010. Epub 2018 Feb 11.
Multiple sclerosis is an inflammatory demyelinating disease characterized by progressive axonal loss affecting mainly the inner retinal layers. Optical coherence tomography (OCT) provides in-vivo quantification of the retinal layers and allows measuring progressive retinal changes. Our objective was to assess the longitudinal changes in the retina using spectral domain OCT (SDOCT) and to identify independent predictors affecting retinal thinning in MS patients.
A prospective study in a tertiary care MS center was conducted to study the longitudinal retinal changes in MS patients. All subjects underwent baseline and follow up OCT assessment with segmentation analysis. Regression analysis was performed to assess clinical factors (age, sex, disease duration, history of optic neuritis before baseline, non-ocular clinical relapses) and MRI disease activity during the follow-up period.
The study included 102 MS patients with a mean follow-up duration of 3.9 ± SD years. At the last follow-up assessments, there were significant thinning of the average macular thickness (AMT) (p < .001), macular nerve fiber layer (MRNFL) (p < .001), ganglion cell-inner plexiform layer (GCIPL) (p < .001), and the peripapillary nerve fiber layer (PRNFL) (p < .001), compared to baseline. Early disease duration up to 10 years was associated with thinning of AMT, PRNFL, and GCIPL, while longer disease duration (> 15 years) was associated with only GCIPL thinning. Prior optic neuritis was predictive of more thinning of PRNFL (p = < .01), while MRI activity and female gender were significantly associated with more MRNFL thinning (p = < .01).
MS is associated with longitudinal thinning affecting AMT inner retinal layers (MRNFL, GCIPL, PRNFL). Early disease duration, female gender, MRI activity, and prior optic neuritis were predictive of faster rate of neuro-axonal loss. This may have implications in the design of future therapeutic trials.
多发性硬化症是一种炎症性脱髓鞘疾病，其特征是进行性轴突丧失，主要影响内视网膜层。光学相干断层扫描（OCT）提供了视网膜层的体内定量，并允许测量进行性视网膜变化。我们的目的是使用频域 OCT（SDOCT）评估视网膜的纵向变化，并确定影响 MS 患者视网膜变薄的独立预测因素。
在一家三级护理 MS 中心进行了一项前瞻性研究，以研究 MS 患者的纵向视网膜变化。所有患者均进行基线和随访 OCT 评估，并进行分段分析。回归分析用于评估临床因素（年龄、性别、疾病持续时间、基线前视神经炎史、非眼部临床复发）和随访期间的 MRI 疾病活动。
该研究包括 102 名 MS 患者，平均随访时间为 3.9 ± SD 年。在最后一次随访评估中，平均黄斑厚度（AMT）（p <.001）、黄斑神经纤维层（MRNFL）（p <.001）、神经节细胞-内丛状层（GCIPL）（p <.001）和视盘神经纤维层（PRNFL）（p <.001）较基线明显变薄。疾病早期持续时间达 10 年与 AMT、PRNFL 和 GCIPL 变薄有关，而疾病持续时间较长（> 15 年）仅与 GCIPL 变薄有关。先前的视神经炎与 PRNFL 变薄更多有关（p = <.01），而 MRI 活动和女性性别与更多的 MRNFL 变薄显著相关（p = <.01）。
MS 与影响 AMT 内视网膜层（MRNFL、GCIPL、PRNFL）的纵向变薄有关。早期疾病持续时间、女性性别、MRI 活动和先前的视神经炎是神经轴突丧失更快的预测因素。这可能对未来治疗试验的设计具有重要意义。
