Anatomical and functional retinal changes in multiple sclerosis

Optociliary shunt vessels in multiple sclerosis

BACKGROUND/INTRODUCTION

Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence.

OBJECTIVE

To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis.

CASES

This case series follows two patients with multiple sclerosis from August 1st, 2019 to April 24th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted.

CONCLUSIONS

We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.

Evaluation of optical coherence tomography findings in patients with multiple sclerosis and glaucoma

PURPOSE

Glaucoma and multiple sclerosis (MS) can cause optic disc pathology and, in this way, affect optical coherence tomography (OCT) data. In this context, the objective of this study is to investigate the changes in the mean, quadrant, and sector data measured by OCT in glaucoma and MS patients.

METHODS

The sample of this prospective cohort study consisted of 42 MS patients (84 eyes), 34 Primary open-angle glaucomas patients (67 eyes), and 24 healthy control subjects (48 eyes). The MS group was divided into two groups according to the presence of a history of optic neuritis. Accordingly, those with a history of optic neuritis were included in the MS ON group, and those without a history of optic neuritis were included in the MS NON group. The differences between these groups in the mean, quadrant, and sector data related to the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were evaluated.

RESULTS

Superior nasal (SN), superior temporal (ST), inferior nasal (IN), and superior quadrant (SUP) values were significantly lower in the glaucoma group than in the MS group (p < 0.05). The mean superior GCC (GCC SUP) value was significantly lower in the MS ON group than in the glaucoma group (p < 0.05). On the other hand, SN, ST, inferior temporal (IT), IN, average RNFL (AVE RNFL), semi-average superior RNFL (SUP AVE RNFL), semi-average inferior RNFL (INF AVE RNFL), SUP, and inferior quadrant RNFL (INF) values were significantly lower in the glaucoma group than in the MS NON group (p < 0.05).

CONCLUSION

RNFL and GCC parameters get thinner in MS and glaucoma patients. While the inferior and superior RNFL quadrants are more frequently affected in glaucoma patients, the affected quadrants vary according to the presence of a history of optic neuritis in MS patients. It is noteworthy that the GCC superior quadrant was thin in MS ON patients. The findings of this study indicate that OCT data may be valuable in the differential diagnosis of glaucoma and MS.

Non-invasive in vivo imaging of brain and retinal microglia in neurodegenerative diseases

Microglia play crucial roles in immune responses and contribute to fundamental biological processes within the central nervous system (CNS). In neurodegenerative diseases, microglia undergo functional changes and can have both protective and pathogenic roles. Microglia in the retina, as an extension of the CNS, have also been shown to be affected in many neurological diseases. While our understanding of how microglia contribute to pathological conditions is incomplete, non-invasive in vivo imaging of brain and retinal microglia in living subjects could provide valuable insights into their role in the neurodegenerative diseases and open new avenues for diagnostic biomarkers. This mini-review provides an overview of the current brain and retinal imaging tools for studying microglia in vivo. We focus on microglia targets, the advantages and limitations of in vivo microglia imaging approaches, and applications for evaluating the pathogenesis of neurological conditions, such as Alzheimer's disease and multiple sclerosis.

Phenome- and genome-wide analyses of retinal optical coherence tomography images identify links between ocular and systemic health

The human retina is a multilayered tissue that offers a unique window into systemic health. Optical coherence tomography (OCT) is widely used in eye care and allows the noninvasive, rapid capture of retinal anatomy in exquisite detail. We conducted genotypic and phenotypic analyses of retinal layer thicknesses using macular OCT images from 44,823 UK Biobank participants. We performed OCT layer cross-phenotype association analyses (OCT-XWAS), associating retinal thicknesses with 1866 incident conditions (median 10-year follow-up) and 88 quantitative traits and blood biomarkers. We performed genome-wide association studies (GWASs), identifying inherited genetic markers that influence retinal layer thicknesses and replicated our associations among the LIFE-Adult Study (N = 6313). Last, we performed a comparative analysis of phenome- and genome-wide associations to identify putative causal links between retinal layer thicknesses and both ocular and systemic conditions. Independent associations with incident mortality were detected for thinner photoreceptor segments (PSs) and, separately, ganglion cell complex layers. Phenotypic associations were detected between thinner retinal layers and ocular, neuropsychiatric, cardiometabolic, and pulmonary conditions. A GWAS of retinal layer thicknesses yielded 259 unique loci. Consistency between epidemiologic and genetic associations suggested links between a thinner retinal nerve fiber layer with glaucoma, thinner PS with age-related macular degeneration, and poor cardiometabolic and pulmonary function with a thinner PS. In conclusion, we identified multiple inherited genetic loci and acquired systemic cardio-metabolic-pulmonary conditions associated with thinner retinal layers and identify retinal layers wherein thinning is predictive of future ocular and systemic conditions.

The retina-brain axis and diabetic retinopathy

Diabetic retinopathy (DR) is a major contributor to permanent vision loss and blindness. Changes in retinal neurons, glia, and microvasculature have been the focus of intensive study in the quest to better understand DR. However, the impact of diabetes on the rest of the visual system has received less attention. There are reports of associations of changes in the visual system with preclinical and clinical manifestations of diabetes. Simultaneous investigation of the retina and the brain may shed light on the mechanisms underlying neurodegeneration in diabetics. Additionally, investigating the links between DR and other neurodegenerative disorders of the brain including Alzheimer's and Parkinson's disease may reveal shared mechanisms for neurodegeneration and potential therapy options.

Combining retinal structural and vascular measurements improves discriminative power for multiple sclerosis patients

Data on how retinal structural and vascular parameters jointly influence the diagnostic performance of detection of multiple sclerosis (MS) patients without optic neuritis (MSNON) are lacking. To investigate the diagnostic performance of structural and vascular changes to detect MSNON from controls, we performed a cross-sectional study of 76 eyes from 51 MS participants and 117 eyes from 71 healthy controls. Retinal macular ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thicknesses, and capillary densities from the superficial (SCP) and deep capillary plexuses (DCP) were obtained from the Cirrus AngioPlex. The best structural parameter for detecting MS was compensated RNFL from the optic nerve head (AUC = 0.85), followed by GCC from the macula (AUC = 0.79), while the best vascular parameter was the SCP (AUC = 0.66). Combining structural and vascular parameters improved the diagnostic performance for MS detection (AUC = 0.90; p<0.001). Including both structure and vasculature in the joint model considerably improved the discrimination between MSNON and normal controls compared to each parameter separately (p = 0.027). Combining optical coherence tomography (OCT)-derived structural metrics and vascular measurements from optical coherence tomography angiography (OCTA) improved the detection of MSNON. Further studies may be warranted to evaluate the clinical utility of OCT and OCTA parameters in the prediction of disease progression.

Insights into human health from phenome- and genome-wide analyses of UK Biobank retinal optical coherence tomography phenotypes

The human retina is a complex multi-layered tissue which offers a unique window into systemic health and disease. Optical coherence tomography (OCT) is widely used in eye care and allows the non-invasive, rapid capture of retinal measurements in exquisite detail. We conducted genome- and phenome-wide analyses of retinal layer thicknesses using macular OCT images from 44,823 UK Biobank participants. We performed phenome-wide association analyses, associating retinal thicknesses with 1,866 incident ICD-based conditions (median 10-year follow-up) and 88 quantitative traits and blood biomarkers. We performed genome-wide association analyses, identifying inherited genetic markers which influence the retina, and replicated our associations among 6,313 individuals from the LIFE-Adult Study. And lastly, we performed comparative association of phenome- and genome- wide associations to identify putative causal links between systemic conditions, retinal layer thicknesses, and ocular disease. Independent associations with incident mortality were detected for photoreceptor thinning and ganglion cell complex thinning. Significant phenotypic associations were detected between retinal layer thinning and ocular, neuropsychiatric, cardiometabolic and pulmonary conditions. Genome-wide association of retinal layer thicknesses yielded 259 loci. Consistency between epidemiologic and genetic associations suggested putative causal links between thinning of the retinal nerve fiber layer with glaucoma, photoreceptor segment with AMD, as well as poor cardiometabolic and pulmonary function with PS thinning, among other findings. In conclusion, retinal layer thinning predicts risk of future ocular and systemic disease. Furthermore, systemic cardio-metabolic-pulmonary conditions promote retinal thinning. Retinal imaging biomarkers, integrated into electronic health records, may inform risk prediction and potential therapeutic strategies.

Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography

The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.

Expression of poly(ADP-ribose) polymerase-1 gene and optical coherence tomography angiographic parameters among patients with multiple sclerosis

Back ground/aims

To analyse different parameters of the macula, disc and their vascular affection using optical coherence tomography (OCT) and angiography (OCT-A) in patients with multiple sclerosis (MS) correlating these changes to PARP-1 gene expression in blood.

Methods

This cross-sectional study included 80 eyes of the clinically diagnosed relapsing-remitting phenotype of MS. The study included three groups; group (A) included 40 eyes of 20 patients with MS with a history of optic neuritis (MS+ON), group (B) included 40 eyes of 20 patients with MS without a history of ON (MS-ON) and group (C) (the control group) consisted of 40 eyes of 20 matched participants not suffering from any ocular or systemic disease. OCT and OCT-A, RTVue (Optovue, Fermont, California, USA) were done for all eyes for evaluating the macular and disc changes. Qualitative real-time PCR for estimation of PARP1 gene expression level was performed for all patients.

Results

PARP-1 gene expression level showed a significant difference in comparing the three groups, with the highest level being for the (ON+) group (p<0.0009). Significant negative correlations were found between PARP-1 gene expression level and central macular thickness, total macular volume and full foveal vessel density thickness. ROC curve constructed by plotting the area under the receiver operating characteristic curve value was (0.9) for PARP-1 gene expression level.

Conclusions

PARP-1 may play an important role in the development of the ON cascade in patients with MS and may be a biomarker for diagnosing and a potential molecular target of ON in MS patients’ therapy. In addition to the OCT and OCT-angio changes that could be detected retrospectively, PARP-1 gene expression level could be considered a prospective detector to complete the full-blown picture of MS (ON+) early and prevent blindness.

Optical Coherence Tomography and Optical Coherence Tomography with Angiography in Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory and neurodegenerative, potentially disabling disease of the central nervous system. OCT (Optical Coherence Tomography) and OCT-A (Optical Coherence Tomography with Angiography) are imaging techniques for the retina and choroid that are used in the diagnosis and monitoring of ophthalmological conditions. Their use has recently expanded the study of several autoimmune disorders, including MS. Although their application in MS remains unclear, the results seem promising. This review aimed to provide insight into the most recent OCT and OCT-A findings in MS and may function as a reference point for future research. According to the current literature, the retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform complex (GC-IPL) are significantly reduced in people with MS and are inversely correlated with disease duration. The use of OCT might help distinguish between MS and neuromyelitis optica spectrum disorders (NMOSD), as the latter presents with more pronounced thinning in both the RNFL and GC-IPL. The OCT-A findings in MS include reduced vessel density in the macula, peripapillary area, or both, and the enlargement of the foveal avascular zone (FAZ) in the setting of optic neuritis. Additionally, OCT-A might be able to detect damage in the very early stages of the disease as well as disease progression in severe cases.

Choroidal Thickness in Multiple Sclerosis: An Optical Coherence Tomography Study

Background and Purpose

To identify changes in the choroidal thickness (CT) in multiple sclerosis (MS) patients with and without optic neuritis (ON) using enhanced-depth-imaging optical coherence tomography (EDI-OCT).

Methods

This cross-sectional study included 96 eyes with MS and 28 eyes of healthy controls. All participants underwent an ophthalmologic examination and EDI-OCT scanning (Spectralis, Heidelberg Engineering, Germany) to assess the CT and the retinal nerve fiber layer (RNFL) thickness. MS patients were divided into two groups: 1) with and 2) without a history of ON. The CT was evaluated in the fovea and at six horizontal and six vertical points at 500, 1,000, and 1,500 µm from the fovea. Paired t-tests were used to compare the groups, and p-value<0.05 was considered as significant.

Results

At all 13 measurements points, the CT was thicker in MS patients than in the healthy controls and was thinner in eyes with ON than in the contralateral eyes, but these differences were not statistically significant. However, the CT was always larger in all points in eyes with a history of ON than in the control eyes. The RNFL was significantly thinner (p<0.05) in both MS and ON eyes than in the control eyes.

Conclusions

The CT did not differ between MS and control eyes, but it was significantly larger in patients with a history of ON, in whom the RNFL was thinner. Further studies are necessary to establish the possible role of the choroid in MS.

Relationship between optical coherence tomography angiography and visual evoked potential in patients with multiple sclerosis

Purpose:

This study aimed to identify an easy-to-apply biomarker by correlating visual evoked potential (VEP) with optical coherence tomography angiography (OCTA) results in multiple sclerosis (MS).

Methods:

Our study was planned prospectively. Patients with MS were divided into two groups, VEP prolonged group 1 and VEP normal group 2. Age-matched and gender-matched healthy individuals (group 3) were included as the control group. Vascular density (VD) of the optic nerve head (ONH) and radial peripapillary capillaries (RPCs) were measured and recorded by OCTA. The optic nerve damage of patients was measured and recorded with a VEP device.

Results:

Thirty-two eyes were included in group 1, 50 eyes were included in group 2, and 51 healthy eyes were included in group 3. In terms of visual acuity, group 1 was significantly lower than the other groups (P < 0.001). Regardless of the prolongation of p100 latency in patients with MS, whole image, inside disc ONH VD and in the same sectors in RPC VD were found to be significantly lower than the control group (P < 0.05). Retinal nerve fiber layer thickness was found to be significantly lower in group 1 than in group 2 and group 3 (P < 0.05). There was a significant correlation between low ONH VD and RPC VD and prolonged VEP P100 (P < 0.05).

Conclusion:

VEP measurements can be correlated with OCTA measurements in patients with MS and can be used as a biomarker to determine the degree of optic nerve damage.

Detailed Evaluation of Macular Ganglion Cell Complex in Patients with Multiple Sclerosis

Introduction:

Retinal nerve fiber layer thickness has been used for monitoring of disease activity in patients with multiple sclerosis (MS). Macular ganglion cell complex (GCC) layer of retina also can be measured by OCT and has been suggested as a potential biomarker in MS. In this study we investigated the macular GCC and its role as a potential biomarker in patients with Multiple Sclerosis (MS).

Methods:

A prospective cohort-study, subjects consisted of Relapsing-Remitting MS patients (n=62) and healthy controls (n=60). Eyes of MS patients were divided into two subgroups according to the history of the optic neuritis (ON). Standard peripapillary-RNFL and macular scan protocol, and retinal auto-segmentation of spectral-domain OCT were performed. Macular RNFL (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL), and GCC (the sum of these former three layers) were recorded. The macula was divided into nine sectors using the ETDRS grid (4×9=36 variables).

Results:

In total, 50 eyes of 36 patients had previous ON attacks. 35/36 GCC parameters were thinner in MS patients and subgroups compared to the control group (p<0.05). When the eyes with and without a history of optic neuritis were compared, 25 of 36 parameters were thinner in those with ON. There were strong correlations between visual acuity-GCC parameters and EDSS scores in patients with a history of optic neuritis. However, no such relationship was found in those without an ON story.

Conclusion:

Ganglion cell complex gets thinner in patients with MS with a decreasing order of GCL, IPL, and mRNFL. The examination of GCC in detail could be a beneficial biomarker for MS.

Ocular fixation and macular integrity by microperimetry in multiple sclerosis

PURPOSE

To characterize the fixation and macular integrity of subjects with multiple sclerosis (MS) with and without previous optic neuritis (ON) using microperimetry (MP).

METHODS

Fifty-five eyes of MS patients, subdivided into three groups (28 eyes without ON, 16 with previous ON, and 11 eyes with previous ON in the contralateral eye), and 43 healthy eyes were enrolled (January-November 2018). All cases were evaluated using the MAIA microperimeter (Centervue), analyzing the following parameters: average macular threshold (AT), fixation indexes (P1 and P2), bivariate contour ellipse area (BCEA) for 95% and 63% of points, and horizontal (H) and vertical (V) axes of the ellipse of fixation.

RESULTS

All MS groups showed a significant reduced AT compared with the control group (p < 0.001). This reduction was more representative (p < 0.001) in eyes with previous ON. No statistically significant differences were found between MS patients with and without previous ON (p > 0.05). Mean AT was correlated with the examination time in all three groups (between ρ = - 0.798 p < 0.001 and ρ = - 0.49 p < 0.001). Significant differences in fixation parameters were only found between control and MS with ON groups (p < 0.02). The ratio of the disease showed a significant correlation with fixation parameters in MS groups (p < 0.02), but not with AT.

CONCLUSIONS

In MS patients, macular sensitivity is altered, especially in eyes with previous ON. Likewise, a fixational instability is present in MS patients with ON, with more increase of the V axis of the fixation area than of the H. The ratio of the disease also affects the patient fixation pattern.

Morphological Outer Retina Findings in Multiple Sclerosis Patients With or Without Optic Neuritis

Purpose: To investigate on the morphology of the macular inner (IR) and outer (OR) layers in multiple sclerosis (MS) patients with and without history of optic neuritis (ON), followed by good or poor recovery of best corrected visual acuity (BCVA). Methods: Thirty-five normal control subjects and 93 relapsing remitting MS patients were enrolled. Of this, 40 MS patients without ON (MS-noON, 40 eyes), 27 with history of ON and good BCVA recovery (MS-ON-G, 27 eyes), and 26 with history of ON and poor BCVA recovery (MS-ON-P, 26 eyes) were studied. Controls and MS patients underwent an extensive ophthalmological examination including spectral-domain optical coherence tomography evaluating in 3 localized macular areas (0-1 mm, Area 1; 1-3 mm, Area 2; 3- 6 mm, Area 3), volumes (MV), and thicknesses (MT) of the whole retina (WR), further segmented in IR and OR. The differences of MV and MT between the groups were tested by ANOVA. In the MS-ON-P group, the correlations between MV and MT and BCVA were evaluated by Pearson's test. Results: When compared to controls, the MS-noON group showed not significantly (p > 0.01) different MVs, whereas MTs were significantly (p < 0.01) reduced in the evaluation of WR and IR. In the MS-ON-G group, a significant (p < 0.01) reduction of WR and IR MVs and MTs was found in Areas 2 and 3; OR MVs and MTs were similar (p > 0.01) to controls. In the MS-ON-P group a significant (p < 0.01) reduction of WR, IR, and OR MVs and MTs was detected in all areas; the BCVA reduction was significantly (p < 0.01) correlated with WR and IR MVs and MTs. Conclusions: In MS without history of ON or when ON is followed by a good BCVA recovery, the neurodegenerative process is limited to IR macular layers; in the presence of ON, with a poor BCVA recovery, a morphological impairment of both IR and OR macular layers occurs.

Optical coherence tomography angiography in multiple sclerosis: A cross-sectional study

OBJECTIVES

To evaluate retinal axonal density and retinal capillary flow density (CFD) variations in patients affected by multiple sclerosis (MS) as documented by Optical Coherence Tomography Angiography (OCT-A).

MATERIAL AND METHODS

A cross-sectional study was performed in a tertiary university eye hospital on 94 eyes from 48 MS patients compared to 37 eyes from 23 matched controls. MS patients were divided in two groups: those with previous episodes of optic neuritis (MS ON+, 71.4%) and those without any previous visual complaint (no optic neuritis group, MS ON, 28.6%). Patients underwent macular and optic nerve head OCT-A with Optovue XR Avanti (Optovue, Freemont, California) after that preliminary evaluation of the ganglion cell complex (GCC) and of the retinal nerve fiber layer (RNFL) was achieved for each single eye by SD-OCT. CFD was evaluated in three different retinal layers of MS patients and controls: superficial capillary plexus (SCP), deep capillary plexus (DCP) and the choriocapillaris layer (CL). Each layer was analyzed in 18 preset subregions automatically detected by the system. CFD values were then correlated to the RNFL thickness and GCC thickness in the groups: p values were computed by t-tests between each group of MS patients and controls. A p-value of <0.05 was considered significant.

RESULTS

A significant difference in the overall CFD values was found between ON+ and ON- patients when compared to controls in 18 subregions of SCP. Furthermore, a significant difference was found between MS patients and controls in 16 subregions analyzed corresponding to the CL layer without difference between the two MS subgroups (ON+ and ON-).

CONCLUSIONS

OCT-A when performed at the optic nerve head level and at the macular region is characterized by a reduction of retinal perfusion in a significant portion of MS patients independently if they had a previous history of optic nerve inflammation or not.

Peripapillary Vessel Density as Early Biomarker in Multiple Sclerosis

Background: To evaluate retinal vessel density (VD) in macular and in peripapillary regions in patients with recent onset of multiple sclerosis, at initial demyelinating event (IDE) and in matched relapsing-remitting multiple sclerosis (RRMS) patients.

Methods: We evaluated VD in superficial capillary plexus, deep capillary plexus, choriocapillaris and radial peripapillary capillary plexus in IDE, RRMS patients and in matched healthy controls (HCs) through Optical Coherence Tomography Angiography (OCT-A). Clinical history, including history of optic neuritis, Expanded Disability Status scale and disease duration of patients were collected.

Results: Thirty patients (20 with IDE and 10 with RRMS) and 15 HCs were enrolled. IDE patients showed a lower VD in radial peripapillary capillary plexus compared with controls (coeff. β = −3.578; p = 0.002). RRMS patients displayed a lower VD in both superficial capillary plexus and radial peripapillary capillary plexus compared with HCs (coeff. β = −4.955; p = 0.002, and coeff. β = −7.446; p < 0.001, respectively). Furthermore, RRMS patients showed a decreased VD in radial peripapillary capillary plexus compared with IDE patients (coeff. β = −3.868; p = 0.003).

Conclusions: Peripapillary region vessel density reduction, revealed through OCT-A, might be considered as an early event in MS, and might be relevant as a biomarker of disease pathology.

Cognitive and physical disability in Egyptian patients with multiple sclerosis: genetic and optical coherence tomography study

Objectives: The aim of this study was to explore the relationship between cognitive dysfunction, neurodegeneration, and genetic factors among multiple sclerosis (MS) patients. Methods: Fifty patients of definite MS were included. Physical disability was assessed by expanded disability status scale (EDSS). Cognitive functions were assessed by using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). For each eye, optical coherence tomography (OCT) was used to track thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), respecting the previous history of optic neuritis (ON). All patients were genotyped for glutamate N-methyl-D-aspartate receptors (NMDARs). Results: A statistically significant negative correlation was found between scores of EDSS and each of neuropsychological tests scores and thickness of both RNFL and GCC. The predictor for progressive disability assessed by EDSS was Symbol Digit Modalities Test (SDMT) (P = 0.021), that is dependent on the educational level of the patients (P = 0.016). A statistically significant positive correlation was found between scores of all neuropsychological tests and the thickness of both RNFL and GCC. Eighty-three percent of MS patients with CC genotype reported previous attacks of ON with significant thinning in RNFL and GCC despite their higher cognitive performance in comparison to other genotypes. Discussion: Deficit in information processing speed measured by SDMT is a predictor of early progressive disability in MS patients. Thinning of RNFL and GCC is a potential biomarker for cognitive and physical disability in MS. The CC genotype of glutamate NMDAR gene has a divergent effect on visual and cognitive functions.

Retinal nerve fiber layer and ganglion cell layer changes on optical coherence tomography in early multiple sclerosis and optic neuritis cases

PURPOSE

To study the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) changes on optical coherence tomography in early multiple sclerosis (MS) patients.

METHODS

A prospective cohort study was conducted at a tertiary care center. Patients of early MS (expanded disability status scale <3) with or without optic neuritis (ON) and idiopathic ON were included. Twenty age-matched individuals were taken as controls. Changes in RNFL and GCL thickness were evaluated along with the correlation with visual function parameters such as visual acuity, contrast sensitivity, and visual evoked response at first visit and again at six months.

RESULTS

Forty-four patients of MS with or without ON (24 and 20 patients respectively), 29 patients with idiopathic ON, and 20 healthy controls constituted the cohorts. Mean LogMAR best-corrected visual acuity was found to be significantly reduced in all groups except fellow eyes (FE) of ON group. Mean values of average RNFL thickness and values in superior, temporal, and inferior quadrant were significantly reduced. Similarly, overall mean values of average GCL-inner plexiform layer (IPL) thickness and values in superior, superonasal, superotemporal, inferonasal, and inferotemporal quadrant were significantly reduced in all groups except FE of ON group (P < 0.05). All the visual parameters significantly correlated with GCL + IPL thickness.

CONCLUSION

GCL + IPL thickness is a more sensitive clinical structural marker than RNFL in early MS with/without ON and ON patients and correlates with all the visual parameters better than RNFL thickness.

Longitudinal quantitative assessment of macula during therapy with fingolimod in relapsing-remitting multiple sclerosis

PURPOSE

Fingolimod is the first oral drug approved for treatment of relapsing-remitting multiple sclerosis (RR-MS), and it has potential macular side effects. Despite the qualitative evidence of macular oedema under treatment, longitudinal quantitative assessment is lacking. To address this issue, we measured macular volume and central foveal thickness in a cohort of MS patients on fingolimod over 12 months of treatment.

METHODS

Central foveal thickness (CFT) and total macular volume (TMV) were longitudinally recorded with spectral-domain optical coherence tomography in a cohort of 23 RR-MS patients treated with fingolimod at baseline, 3, 6 and 12 months. OCT parameters were analysed considering previous history of optic neuritis (ON). Comparison of means was performed with variance analysis (ANOVA).

RESULTS

Macular oedema occurred in none of the patients. Comparing both groups of patients (with and without previous ON), no statistically significant difference was found during the follow-up both for CFT and TMV (p = 0.99 and p = 0.96, respectively) although a slight early but not significant TMV reduction was detected.

CONCLUSIONS

In our cohort, therapy with fingolimod did not cause any change in CFT and TMV in MS patients during a 12-month follow-up independent of previous ON.

Optical coherence tomography angiography retinal vascular network assessment in multiple sclerosis

Background:

Optical coherence tomography (OCT) angiography is a new method to assess the density of the vascular networks. Vascular abnormalities are considered involved in multiple sclerosis (MS) pathology.

Objective:

To assess the presence of vascular abnormalities in MS and to evaluate their correlation to disease features.

Methods:

A total of 50 MS patients with and without history of optic neuritis (ON) and 46 healthy subjects were included. All underwent spectral domain (SD)-OCT and OCT angiography. Clinical history, Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and disease duration were collected.

Results:

Angio-OCT showed a vessel density reduction in eyes of MS patients when compared to controls. A statistically significant reduction in all SD-OCT and OCT angiography parameters was noticed both in eyes with and without ON when compared with control eyes. We found an inverse correlation between SD-OCT parameters and MSSS ( p = 0.003) and between vessel density parameters and EDSS ( p = 0.007).

Conclusion:

We report a vessel density reduction in retina of MS patients. We highlight the clinical correlation between vessel density and EDSS, suggesting that angio-OCT could be a good marker of disease and of disability in MS.