Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Eur J Neurol. 2021 Jul;28(7):2280-2293. doi: 10.1111/ene.14766. Epub 2021 Mar 23.
Foveal changes were reported in aquaporin-4 antibody (AQP4-Ab) seropositive neuromyelitis optica spectrum disorder (NMOSD) patients; however, it is unclear whether they are independent of optic neuritis (ON), stem from subclinical ON or crossover from ON in fellow eyes. Fovea morphometry and a statistical classification approach were used to investigate if foveal changes in NMOSD are independent of ON and progressive.
This was a retrospective longitudinal study of 27 AQP4-IgG + NMOSD patients (49 eyes; 15 ON eyes and 34 eyes without a history of ON [NON eyes]), follow-up median (first and third quartile) 2.32 (1.33-3.28), and 38 healthy controls (HCs) (76 eyes), follow-up median (first and third quartile) 1.95 (1.83-2.54). The peripapillary retinal nerve fibre layer thickness and the volume of combined ganglion cell and inner plexiform layer as measures of neuroaxonal damage from ON were determined by optical coherence tomography. Nineteen foveal morphometry parameters were extracted from macular optical coherence tomography volume scans. Data were analysed using orthogonal partial least squares discriminant analysis and linear mixed effects models.
At baseline, foveal shape was significantly altered in ON eyes and NON eyes compared to HCs. Discriminatory analysis showed 81% accuracy distinguishing ON vs. HCs and 68% accuracy in NON vs. HCs. NON eyes were distinguished from HCs by foveal shape parameters indicating widening. Orthogonal partial least squares discriminant analysis discriminated ON vs. NON with 76% accuracy. In a follow-up of 2.4 (20.85) years, no significant time-dependent foveal changes were found.
The parafoveal area is altered in AQP4-Ab seropositive NMOSD patients suggesting independent neuroaxonal damage from subclinical ON. Longer follow-ups are needed to confirm the stability of the parafoveal structure over time.
水通道蛋白 4 抗体（AQP4-Ab）阳性视神经脊髓炎谱系疾病（NMOSD）患者出现了黄斑改变，但尚不清楚这些改变是否与视神经炎（ON）有关，是源于亚临床 ON，还是来自对侧眼的交叉 ON。本研究采用黄斑形态测量和统计学分类方法，旨在探讨 NMOSD 患者的黄斑改变是否与 ON 及其进展有关。
这是一项回顾性纵向研究，纳入了 27 例 AQP4-IgG+NMOSD 患者（49 只眼；15 只患眼和 34 只无 ON 病史的眼[非患眼]），随访中位数（第 1 四分位数和第 3 四分位数）为 2.32（1.33-3.28），以及 38 名健康对照者（76 只眼），随访中位数（第 1 四分位数和第 3 四分位数）为 1.95（1.83-2.54）。通过光学相干断层扫描（OCT）测量视神经病变导致的视盘周围视网膜神经纤维层厚度和联合神经节细胞和内丛状层的体积。从黄斑 OCT 容积扫描中提取了 19 项黄斑形态测量参数。采用正交偏最小二乘判别分析和线性混合效应模型进行数据分析。
基线时，与健康对照者相比，ON 眼和非患眼的黄斑形态均发生了显著改变。判别分析显示，ON 眼与健康对照者的鉴别准确率为 81%，而非患眼与健康对照者的鉴别准确率为 68%。非患眼通过表明变宽的黄斑形态参数与健康对照者区分开来。正交偏最小二乘判别分析区分 ON 眼与非患眼的准确率为 76%。在 2.4（20.85）年的随访中，未发现黄斑有明显的时间依赖性变化。
AQP4-Ab 阳性 NMOSD 患者的旁中心区发生了改变，提示存在亚临床 ON 引起的独立神经轴突损伤。需要更长时间的随访来确认旁中心结构随时间的稳定性。
