Papadopoulou Athina, Oertel Frederike Cosima, Zimmermann Hanna, Zeitz Oliver, Brandt Alexander U, Paul Friedemann
NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Neurologie, Universitätsspital Basel, Schweiz.
Klin Monbl Augenheilkd. 2018 Nov;235(11):1242-1258. doi: 10.1055/a-0715-7961. Epub 2018 Nov 20.
Retinal changes and visual symptoms are present in several inflammatory, degenerative and tumorous disorders of the central nervous system (CNS). Optical coherence tomography (OCT) is a method that can be used in clinical practice to detect and quantify the structural correlates of these visual symptoms in neurological disorders. OCT is a non-invasive imaging technique, based on interferometry, which can create high-resolution images of the retina and measure the thickness and volume of the different retinal layers. The combined ganglion cell- and inner plexiform layer (GCIPL) and the peripapillary retinal nerve fibre layer (pRNFL) are of particular interest in the field of neurological disorders, since they contain the neuronal bodies (ganglion cells) and their axons that form the optic nerve. In acute optic neuritis (ON), initial swelling of the pRNFL can be detected by OCT and this may contribute to the diagnosis and differential diagnosis of ON; moreover, the extent of the GCIPL-thinning within the first 4 weeks after an acute ON can contribute to the prediction of the long-term visual recovery. However, the role of OCT in the field of multiple sclerosis (MS) is not restricted in patients with ON, since even eyes without an ON-history show mild thinning of the pRNFL and GCIPL. This thinning seems to be associated with neurodegenerative processes in the entire CNS. Several studies showed correlations between these OCT-parameters and a higher risk of clinical deterioration (disability progression), cognitive deficits and disease activity in patients with MS. However, it is often still unclear how these correlations can be useful in the management of the individual patient. In recent years, OCT has been applied to a greater extent to neurodegenerative diseases, such as Parkinson's disease, amyotrophic lateral sclerosis (ALS) and various forms of dementia. However, routine clinical use is still further away than for inflammatory CNS diseases, since the role of OCT in the diagnosis, differential diagnosis and prediction of the clinical course of neurodegenerative diseases is still unclear. This review article offers a summary of the available study results on OCT parameters and their role in inflammatory, degenerative and tumorous diseases of the central nervous system (CNS).
视网膜变化和视觉症状存在于中枢神经系统（CNS）的多种炎症性、退行性和肿瘤性疾病中。光学相干断层扫描（OCT）是一种可用于临床实践的方法，用于检测和量化神经疾病中这些视觉症状的结构相关性。OCT是一种基于干涉测量的非侵入性成像技术，可创建视网膜的高分辨率图像，并测量不同视网膜层的厚度和体积。在神经疾病领域，联合神经节细胞和内网状层（GCIPL）以及视乳头周围视网膜神经纤维层（pRNFL）特别受关注，因为它们包含形成视神经的神经元体（神经节细胞）及其轴突。在急性视神经炎（ON）中，OCT可检测到pRNFL的初始肿胀，这可能有助于ON的诊断和鉴别诊断；此外，急性ON后4周内GCIPL变薄的程度有助于预测长期视力恢复情况。然而，OCT在多发性硬化症（MS）领域的作用并不局限于患有ON的患者，因为即使没有ON病史的眼睛也显示出pRNFL和GCIPL轻度变薄。这种变薄似乎与整个CNS的神经退行性过程有关。多项研究表明，这些OCT参数与MS患者临床恶化（残疾进展）、认知缺陷和疾病活动的较高风险之间存在相关性。然而，这些相关性如何在个体患者的管理中发挥作用往往仍不清楚。近年来，OCT在更大程度上已应用于神经退行性疾病，如帕金森病、肌萎缩侧索硬化症（ALS）和各种形式的痴呆症。然而，常规临床应用距离炎症性CNS疾病仍较远，因为OCT在神经退行性疾病的诊断、鉴别诊断和临床病程预测中的作用仍不清楚。这篇综述文章总结了关于OCT参数及其在中枢神经系统（CNS）炎症性、退行性和肿瘤性疾病中作用的现有研究结果。
