评估抗降钙素基因相关肽单克隆抗体对偏头痛患者视网膜特征的影响：一项回顾性光学相干断层扫描研究
Evaluating the impact of anti-CGRP monoclonal antibodies on retinal features in migraine patients: a retrospective optical coherence tomography study.
作者信息
Cesareo Massimo, Martucci Alessio, Bovenzi Roberta, Lombardo Marco, Pistoia Francesca, D'Agostino Vittoria Carla, Stefani Alessandro, Nucci Carlo, Mercuri Nicola Biagio, Albanese Maria
机构信息
Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
出版信息
Ther Adv Neurol Disord. 2025 Jun 24;18:17562864251347277. doi: 10.1177/17562864251347277. eCollection 2025.
BACKGROUND
Migraine is a disabling neurovascular disorder characterized by recurrent attacks that lead to extracranial and visual involvement. Several studies have investigated the retinal vasculature features in individuals with migraine, but there have been conflicting results.
OBJECTIVE
To evaluate retinal structure in migraine patients before (T0) and after 6-month therapy (T1) with anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), using optical coherence tomography (OCT) imaging.
DESIGN
A case-control and longitudinal study was conducted between January 2021 and December 2023, including 20 eyes from 10 healthy controls (HCs) and 32 eyes of 16 patients with migraine and treated with anti-CGRP mAbs according to AIFA criteria.
METHODS
Patients underwent OCT angiography (OCT-A) to assess retinal vessel density (VD) and spectral-domain OCT (SD-OCT) to evaluate central retinal thickness, macular structure, and peripapillary retinal nerve fiber layer thickness. These parameters were assessed in both groups at T0 and again after 6 months (T1) as part of routine clinical care.
RESULTS
All migraineurs exhibited a significant reduction in disease disability at T1, as assessed by clinical parameters. OCT data analysis revealed that individuals with migraine showed a significant increase in temporal retinal nerve fiber layer (RNFL) thickness and a reduction in nasal RNFL thickness compared to HCs. No differences in retinal circulation were observed between the groups at baseline. At T1, RNFL thickness remained sustained in the superior temporal sector, while the percentage VD of the superficial capillary plexus and radial peripapillary capillary significantly increased in the nasal perifoveal, inferior temporal, and hemi-inferior subregions.
CONCLUSION
Our study suggests that specific retinal structural changes could precede vascular dysfunction in migraine and can be detected early by combining SD-OCT and OCT-A acquisitions. Short-term treatment with anti-CGRP mAbs may exert neuroprotective effects, potentially preventing permanent ocular damage.
TRIAL REGISTRATION
EyeHEAD Study (Trial registration number AIFA July/2024: IT 1735, www.aifa.gov.it/registro-studi-osservazionali).
背景
偏头痛是一种致残性神经血管疾病，其特征为反复发作，可导致颅外和视觉受累。多项研究调查了偏头痛患者的视网膜血管系统特征，但结果相互矛盾。
目的
使用光学相干断层扫描（OCT）成像评估偏头痛患者在接受抗降钙素基因相关肽（CGRP）单克隆抗体（mAb）治疗6个月前（T0）和治疗后（T1）的视网膜结构。
设计
于2021年1月至2023年12月进行了一项病例对照和纵向研究，包括来自10名健康对照者（HC）的20只眼和16名偏头痛患者并根据意大利药品管理局（AIFA）标准接受抗CGRP mAb治疗的32只眼。
方法
患者接受OCT血管造影（OCT-A）以评估视网膜血管密度（VD），并接受光谱域OCT（SD-OCT）以评估中央视网膜厚度、黄斑结构和视乳头周围视网膜神经纤维层厚度。作为常规临床护理的一部分，在T0时对两组进行这些参数评估，并在6个月后（T1）再次评估。
结果
根据临床参数评估，所有偏头痛患者在T1时疾病致残率均显著降低。OCT数据分析显示，与HC相比，偏头痛患者颞侧视网膜神经纤维层（RNFL）厚度显著增加，鼻侧RNFL厚度降低。两组在基线时未观察到视网膜循环差异。在T1时，颞上象限的RNFL厚度持续保持，而鼻侧中央凹周围、颞下和半下区域的浅表毛细血管丛和视乳头周围放射状毛细血管的VD百分比显著增加。
结论
我们的研究表明，偏头痛中特定的视网膜结构变化可能先于血管功能障碍，并且通过结合SD-OCT和OCT-A采集可以早期检测到。抗CGRP mAb的短期治疗可能发挥神经保护作用，潜在地预防永久性眼部损伤。
试验注册
EyeHEAD研究（试验注册号AIFA 2024年7月：IT 1735，www.aifa.gov.it/registro-studi-osservazionali）。
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