Elsevier

Ophthalmology

Volume 120, Issue 2, February 2013, Pages 387-394
Ophthalmology

Original article
Evaluation of Inner Retinal Layers in Patients with Multiple Sclerosis or Neuromyelitis Optica Using Optical Coherence Tomography

https://doi.org/10.1016/j.ophtha.2012.07.066Get rights and content

Purpose

To evaluate the thickness of the inner retinal layers in the macula using frequency-domain optical coherence tomography (fd-OCT) in patients with demyelinating diseases.

Design

Cross-sectional study.

Participants

A total of 301 eyes of 176 subjects were evaluated. Subjects were divided in 5 different groups: controls, neuromyelitis optica (NMO), longitudinally extensive transverse myelitis (LETM), multiple sclerosis with a history of optic neuritis (MS-ON), and multiple sclerosis without a history of optic neuritis (MS non-ON).

Methods

The individual layers from macular fd-OCT cube scans were segmented with an automated algorithm and then manually hand-corrected. For each scan, we determined the thickness of the retinal nerve fiber layer (RNFL), the combined retinal ganglion cell and inner plexiform layers (RGCL+), and the inner nuclear layer (INL).

Main Outcome Measures

Macular RNFL, RGCL+, and INL thickness.

Results

The RNFL was significantly thinner than in controls for all patient groups (P≤0.01). Macular RGCL+ thickness was significantly thinner than in controls for the NMO, MS-ON, and MS non-ON groups (P<0.001 for the 3 groups). The INL thickness was significantly thicker than in controls for the patients with NMO (P = 0.003) and LETM (P = 0.006) but not for those with MS-ON or MS non-ON. Although the RNFL and RGCL+ were not significantly different between the NMO and MS-ON groups, the patients with NMO had a significantly thicker INL than the patients with MS-ON (P = 0.02).

Conclusions

Macular RNFL and RGCL+ demonstrate axonal and neural loss in patients with MS, either with or without ON, and in patients with NMO. In addition, the INL thickening occurs in patients with NMO and patients with LETM, and study of this layer may hold promise for differentiating between NMO and MS.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Study Design and Sampling

This was an observational, prospective cross-sectional study. Participants were recruited from the Department of Neurology of the University of São Paulo Medical School. Approval from the institutional review board ethics committee was obtained for the study. The study followed the principles of the Declaration of Helsinki, and informed consent was obtained from all participants. This study is registered on www.clinicaltrials.gov, under identifier NCT01024985 (accessed December 2, 2009).

A total

Results

A total of 301 eyes were evaluated and separated in 5 groups. NMO: 46 eyes from 29 patients with NMO (anti-NMO positive = 22 eyes, only 1 episode of ON = 33 eyes); LETM: 56 eyes from 29 patients with LETM (anti-NMO positive = 20 eyes); MS-ON: 41 eyes of 29 patients with MS previously affected with ON (MS-ON, only 1 episode of ON = 28 eyes); MS non-ON: 74 eyes of 44 patients without previous episodes of ON (MS non-ON); and controls: 84 eyes of 45 controls. Table 1 shows the demographic data of

Discussion

In a large population of patients with NMO spectrum or MS using fd-OCT, we found that both macular RNFL and RGCL+ were statistically thinner in MS with or without ON when compared with normal controls. These findings are consistent with the hypothesis that optic nerve demyelination results in retrograde axonal degeneration, culminating in ganglion cell death.24 It also helps supports the notion that axonal and neuronal loss are present even in the eyes of patients with MS without a clinical

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    Manuscript no. 2012-527.

    Financial Disclosure(s): The author(s) have made the following disclosure(s):

    D.B.F., none; A.S.R., none; R.N., none; D.W., none; D.C., none; D.C.H., Topcon Corp (Tokyo, Japan); M.L.R.M., none.

    Supported by grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (grant no. 2009/50174-0); CAPES—Coordenação de Aperfeiçoamento de Nível Superior (no. 4951-10-07), Brasília, Brazil; CNPq—Conselho Nacional de Desenvolvimento Científico e Tecnológico (no. 306487/2011-0), Brasília, Brazil; and National Institutes of Health (EY02115). The funding organizations had no role in the design or conduct of this research.

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