Kalaitzidis Grigorios, Ezzedin Omar, Bacchetti Anna, Moussa Hussein, Murphy Olwen C, Filippatou Angeliki G, Ehrhardt Henrik, Vasileiou Eleni, Pellegrini Nicole, Davis Simidele, Douglas Morgan, Fitzgerald Kathryn C, DuVal Anna, Douglas Newsome Scott, Sotirchos Elias S, Nourbakhsh Bardia, Dewey Blake E, Prince Jerry, Saidha Shiv, Calabresi Peter A
Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Mult Scler. 2024 Dec;30(14):1802-1814. doi: 10.1177/13524585241297816. Epub 2024 Nov 23.
Retrograde trans-synaptic degeneration (TSD) following retro-chiasmal pathology, typically retro-geniculate in multiple sclerosis (MS), may manifest as homonymous hemi-macular atrophy (HHMA) of the ganglion cell/inner plexiform layer (GCIPL).
To determine the frequency, association with clinical outcomes, and retinal and radiological features of HHMA in people with MS (PwMS).
In this cross-sectional study, healthy controls (HC) and PwMS underwent retinal optical coherence tomography scanning. For quantitative identification of HHMA, a normalized asymmetry ratio was used, and its normative cutoffs were established from the HC. HHMA PwMS were propensity score matched 1:2 to non-HHMA PwMS. Mixed-effects linear regression models were used in analyses.
Based on normative data from 238 HC (466 eyes), 79 out of 942 PwMS exhibited HHMA (8.4%; 143 eyes). Compared to non-HHMA eyes from matched PwMS (158 PwMS; 308 eyes), HHMA eyes had lower average GCIPL (diff: -5.7 μm (95% CI -7.6 to -3.8); < 0.001) but also inner nuclear layer (diff: -0.9 μm (95% CI -1.6 to -0.1); = 0.02), and outer nuclear layer (diff: -1.9 μm (95% CI -3.4 to -0.4); = 0.02) thicknesses; in further analyses, these differences were exclusive to the homonymous side of HHMA. HHMA participants also exhibited higher expanded disability status scale scores (diff: 0.5 (95% CI 0.1 to 0.9); = 0.02), worse 100% and 2.5% visual acuity scores (diff: -3.2 (95% CI -4.1 to -1.0); = 0.002, -5.4 (95% CI -7.5 to -3.5); < 0.001), and higher frequency of microcystoid macular changes (10.1% vs. 3.2%; = 0.03) compared to non-HHMA participants.
HHMA, possibly as a marker of TSD, may signify higher disability in MS.
视交叉后病变（通常在多发性硬化症（MS）中为膝状体后病变）后的逆行性跨突触变性（TSD）可能表现为神经节细胞/内丛状层（GCIPL）的同侧半黄斑萎缩（HHMA）。
确定MS患者（PwMS）中HHMA的发生率、与临床结局的关联以及视网膜和影像学特征。
在这项横断面研究中，健康对照（HC）和PwMS接受了视网膜光学相干断层扫描。为了定量识别HHMA，使用了标准化不对称率，并根据HC建立了其正常临界值。HHMA的PwMS与非HHMA的PwMS按倾向得分1:2进行匹配。分析中使用了混合效应线性回归模型。
根据238名HC（466只眼）的正常数据，942名PwMS中有79名表现出HHMA（8.4%；143只眼）。与匹配的PwMS的非HHMA眼（158名PwMS；308只眼）相比，HHMA眼的平均GCIPL较低（差异：-5.7μm（95%CI -7.6至-3.8）；<0.001），但内核层（差异：-0.9μm（95%CI -1.6至-0.1）；=0.02）和外核层（差异：-1.9μm（95%CI -3.4至-0.4）；=0.02）厚度也较低；在进一步分析中，这些差异仅见于HHMA的同侧。与非HHMA参与者相比，HHMA参与者还表现出更高的扩展残疾状态量表评分（差异：0.5（95%CI 0.1至0.9）；=0.02）、更差的100%和2.5%视力评分（差异：-3.2（95%CI -4.1至-1.0）；=0.002，-5.4（95%CI -7.5至-3.5）；<0.001）以及更高的微囊样黄斑改变频率（10.1%对3.2%；=0.03）。
HHMA可能作为TSD的标志物，可能表明MS患者的残疾程度更高。
