From the Departments of Ophthalmology (S.C.X., J.A.L., J.J.C.) and Neurology (E.P.F., S.J.P., J.J.C.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology (R.H.K.), University of Iowa, Iowa City.
Neurology. 2019 Feb 5;92(6):e527-e535. doi: 10.1212/WNL.0000000000006873. Epub 2019 Jan 23.
To explore sensitivity of optical coherence tomography (OCT) in detecting prior unilateral optic neuritis.
This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral optic neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye.
Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with optic neuritis compared to unaffected eyes ( < 0.001). RNFL was thinner by ≥9 µm in 73% of optic neuritis eyes compared to the unaffected eye. GCIPL was thinner by ≥6 µm in 96% of optic neuritis eyes, which was more sensitive than using RNFL ( < 0.001). When using a threshold ≤1st percentile of age-matched controls, sensitivities were 37% for RNFL and 76% for GCIPL, each of which was lower than those calculated using the intereye difference as the threshold ( < 0.01).
OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior optic neuritis, which is made more robust by using intereye differences to approximate change.
This study provides Class III evidence that OCT accurately identifies patients with prior unilateral optic neuritis.
探讨光学相干断层扫描（OCT）在检测单侧视神经炎中的敏感性。
这是一项回顾性、观察性临床研究，纳入了所有 2014 年 1 月 1 日至 2017 年 1 月 6 日期间因单侧视神经炎就诊且至少在发病后 3 个月行 OCT 检查的患者。我们比较了受累眼和未受累对侧眼的视网膜神经纤维层（RNFL）和神经节细胞内丛状层（GCIPL）厚度。我们排除了伴有并发青光眼或其他视神经病变的患者。基于对正常对照者的分析，如果受累眼的 RNFL 比未受累眼至少薄 9 µm 或 GCIPL 至少薄 6 µm，则认为存在变薄。
本研究纳入了 51 例患者（18 名男性和 33 名女性）。与未受累眼相比，视神经炎眼的 RNFL 和 GCIPL 厚度显著降低（<0.001）。与未受累眼相比，73%的视神经炎眼的 RNFL 变薄≥9 µm，96%的视神经炎眼的 GCIPL 变薄≥6 µm，后者比前者更敏感（<0.001）。当使用与年龄匹配的对照者的第 1 百分位以下作为阈值时，RNFL 的敏感度为 37%，GCIPL 的敏感度为 76%，均低于使用眼间差异作为阈值时的敏感度（<0.01）。
OCT，尤其是结合 GCIPL 分析，是一种高度敏感的检测既往视神经炎的方法，通过使用眼间差异来近似变化，可以使该方法更为稳健。
本研究提供了 III 级证据，表明 OCT 能准确识别既往单侧视神经炎患者。
