Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan.
Department of Ophthalmology, Tokyo Shinagawa Hospital, Tokyo, Japan.
Semin Ophthalmol. 2024 Aug;39(6):480-487. doi: 10.1080/08820538.2024.2363849. Epub 2024 Jun 8.
A pallor optic nerve head (ONH) is one of the three features of retinitis pigmentosa (RP). This study aimed to assess the ONH prospectively by color tone, presence of hyper-reflective tissue, blood flow, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) and investigate the change in these parameters with and without ONH pallor.
The presence of ONH pallor was assessed by three independent examiners through careful examination using fundus photographs. The presence of a hyper-reflective structure on the ONH was carefully evaluated using a volume scan optical coherence tomography (OCT). RNFL thickness and ellipsoid zone (EZ) width around the macula were also evaluated by OCT. Laser speckle flowgraphy was used to measure the mean blur rate of the entire ONH area, which was subsequently divided into the vessel area (MV) and tissue area (MT).
Twenty-eight eyes of 28 patients with RP (55.4 ± 16.23 years of age) were included. The pale ONH was observed in 10 (35%) eyes. Hyper-reflective structures were observed in seven (25%) eyes. No significant correlation was found between the pale ONH and the presence of a hyper-reflective structure (Pearson's chi-squared test, = .364). The average of the ONH area, MV, and MT was 8.65 ± 3.08 AU, 17.81 ± 7.54 AU, and 6.4 ± 2.66 AU, respectively, which significantly decreased in patients with pallor ONH (all < .05). The global RNFL thickness was 73.54 ± 18.82 μm. The nasal and superior quadrants and global RNFL thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH (all < .05). The global and superior and inferior GCC thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH(all < .05).There was no difference in the EZ width between patients with and without a pale ONH ( = .107).
We conducted multiple assessments of the ONH in RP patients and investigated its clinical significance. Our findings suggest that ONH pallor may indicate a comprehensive change that emerges alongside the progression of retinal degeneration in RP.
This trial was retrospectively registered in the UMIN Clinical Trial Registry (UMIN ID: 000048168).
苍白视神经乳头（ONH）是视网膜色素变性（RP）的三个特征之一。本研究旨在通过色调、是否存在高反射组织、血流、视网膜神经纤维层（RNFL）厚度、节细胞复合体（GCC）来前瞻性地评估 ONH，并研究在有或没有苍白 ONH 时这些参数的变化。
通过三位独立的检查者仔细检查眼底照片来评估 ONH 苍白的存在。通过体积扫描光学相干断层扫描（OCT）仔细评估 ONH 上是否存在高反射结构。还通过 OCT 评估黄斑周围的 RNFL 厚度和椭圆体区（EZ）宽度。激光散斑血流图用于测量整个 ONH 区域的平均模糊率，随后将其分为血管区域（MV）和组织区域（MT）。
共纳入 28 例 RP 患者（55.4±16.23 岁）的 28 只眼。10 只眼（35%）观察到苍白 ONH。7 只眼（25%）观察到高反射结构。苍白 ONH 与高反射结构的存在之间无显著相关性（Pearson's chi-squared 检验， = .364）。ONH 面积、MV 和 MT 的平均值分别为 8.65±3.08 AU、17.81±7.54 AU 和 6.4±2.66 AU，在苍白 ONH 患者中均显著降低（均<.05）。全球 RNFL 厚度为 73.54±18.82 μm。苍白 ONH 患者的鼻侧和上象限以及全球 RNFL 厚度明显比无苍白 ONH 患者薄（均<.05）。苍白 ONH 患者的全球和上、下 GCC 厚度明显比无苍白 ONH 患者薄（均<.05）。苍白 ONH 患者与无苍白 ONH 患者的 EZ 宽度无差异（ = .107）。
我们对 RP 患者的 ONH 进行了多项评估，并研究了其临床意义。我们的发现表明，ONH 苍白可能表明在 RP 中视网膜变性进展的同时出现了全面变化。
本试验在 UMIN 临床试验注册中心（UMIN ID：000048168）进行了回顾性注册。
