Department of Neurology, Adolphe de Rothschild Foundation Hospital, Paris, France.
Department of Radiology, Adolphe de Rothschild Foundation Hospital, Paris, France.
Eur J Neurol. 2022 Sep;29(9):2781-2791. doi: 10.1111/ene.15420. Epub 2022 Jun 17.
This study was undertaken to determine the role of optical coherence tomography (OCT) in predicting the final visual and structural outcome, and to evaluate the correlation between functional eye outcome and retinal changes, in patients with a first episode of optic neuritis (ON).
In this prospective study, consecutive adult patients with acute ON underwent ophthalmological evaluation at baseline and at 1 and 12 months, including OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell and inner plexiform layer, and inner nuclear layer thicknesses; high- and low-contrast visual acuity; visual field assessment; and baseline brain magnetic resonance imaging. Univariate and multivariate linear regressions were used to assess predictive factors of outcome. Correlations between 12-month visual function and retinal structure were estimated by Spearman coefficients. Two groups of patients were analyzed, with or without multiple sclerosis (MS).
Among 116 patients, 79 (68.1%) had MS, and 37 (31.9%) had ON not related to MS (including 19 idiopathic [i.e., isolated] ON, and 13 and five with myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies, respectively). We found no independent predictive factor of visual and retinal outcome. Analysis of the relationship between the visual field test (mean deviation) and pRNFL thickness demonstrated a threshold of 75.4 μm and 66.4 μm, below which the mean deviation was worse, for patients with MS (p = 0.007) and without MS (p < 0.001), respectively.
We found that inner retinal layer measurements during the first month are not predictive of final outcome. The critical threshold of axonal integrity, below which visual function is damaged, is different between patients with and without MS.
本研究旨在确定光学相干断层扫描（OCT）在预测首发视神经炎（ON）患者最终视力和结构结局中的作用，并评估功能预后与视网膜变化之间的相关性。
本前瞻性研究纳入了连续的急性 ON 成年患者，在基线、1 个月和 12 个月时进行眼科评估，包括 OCT 测量视盘周围视网膜神经纤维层（pRNFL）、黄斑神经节细胞和内丛状层以及内核层厚度；高、低对比度视力；视野评估；以及基线脑磁共振成像。采用单变量和多变量线性回归分析评估预后的预测因素。采用 Spearman 系数评估 12 个月时的视力功能与视网膜结构之间的相关性。分析了存在和不存在多发性硬化症（MS）的两组患者。
在 116 例患者中，79 例（68.1%）患有 MS，37 例（31.9%）患有与 MS 无关的 ON（包括 19 例特发性 ON，13 例和 5 例分别与髓鞘少突胶质细胞糖蛋白和水通道蛋白-4 抗体相关）。我们未发现视力和视网膜预后的独立预测因素。视野检查（平均偏差）与 pRNFL 厚度之间关系的分析显示，MS 患者（p=0.007）和非 MS 患者（p<0.001）的 pRNFL 厚度分别为 75.4 μm 和 66.4 μm 时，平均偏差更差。
我们发现，第一个月内内层视网膜层的测量结果不能预测最终结局。轴突完整性的临界阈值，低于该阈值则会损害视力功能，在 MS 患者和非 MS 患者之间是不同的。
