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El Ayoubi NK, Ismail A, Fahd F, Younes L, Chakra NA, Khoury SJ. Retinal optical coherence tomography measures in multiple sclerosis: a systematic review and meta-analysis. Ann Clin Transl Neurol 2024. [PMID: 39073308 DOI: 10.1002/acn3.52165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Spectral domain-optical coherence tomography plays a crucial role in the early detection and monitoring of multiple sclerosis (MS) pathophysiology. We aimed to quantify differences in retinal layer measures among different groups of MS and explored different variables that correlate with retinal measures. This study was reported according PRISMA guidelines. A comprehensive search was done across PubMed, Embase, and Google Scholar. The mean difference in thickness of retinal layers and macular volume was assessed. Meta-regression was done to assess the sources of heterogeneity. A total of 100 articles were included in the meta-analyses. The peripapillary retinal nerve fiber layer (pRNFL) thickness significantly decreased in the MSON (MD: -16.44, P < 0.001), MSNON (MD: -6.97, P < 0.001), and PMS (MD: -11.35, P < 0.001) versus HC. The macular RNFL was lower among the MSON (MD: -6.24, P = 0.013) and MSNON (MD: -3.84, P <0.001) versus HC. Macular ganglion cell layer and inner plexiform layer (GCIPL) was thinner among MSON (MD: -14.83, P <0.001), MSNON (MD: -6.38, P < 0.001), and PMS (MD: -11.52, P < 0.001) compared with control eyes. Inner nuclear layer (INL) was higher in the MSON (MD: 0.49, P < 0.001) versus HC. Outer nuclear layer (ONL) thickness significantly lower in the MSNON (MD: -1.15, P = 0.019) versus HC. Meta-regression showed that disease duration, age, EDSS score, and percentage of patients taking DMT are all negatively correlated with pRNFL and GCIPL thickness; however, female gender was correlated with less atrophy. As conclusion, the study highlights substantial thinning in the pRNFL and macular GCIPL between MS versus controls. INL as valuable parameter for capturing inflammatory disease activity.
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Affiliation(s)
- Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Ali Ismail
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Beirut, Lebanon
| | - Fares Fahd
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Lama Younes
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Nour A Chakra
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut, Beirut, Lebanon
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Ehrhardt H, Lambe J, Moussa H, Vasileiou ES, Kalaitzidis G, Murphy OC, Filippatou AG, Pellegrini N, Douglas M, Davis S, Nagy N, Quiroga A, Hu C, Zambriczki Lee A, Duval A, Fitzgerald KC, Prince JL, Calabresi PA, Sotirchos ES, Bermel R, Saidha S. Effects of Ibudilast on Retinal Atrophy in Progressive Multiple Sclerosis Subtypes: Post Hoc Analyses of the SPRINT-MS Trial. Neurology 2023; 101:e1014-e1024. [PMID: 37460235 PMCID: PMC10491449 DOI: 10.1212/wnl.0000000000207551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/08/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ganglion cell + inner plexiform layer (GCIPL) thinning, measured by optical coherence tomography (OCT), reflects global neurodegeneration in multiple sclerosis (MS). Atrophy of the inner (INL) and outer nuclear layer (ONL) may also be prominent in progressive MS (PMS). The phase 2, SPRINT-MS trial found reduced brain atrophy with ibudilast therapy in PMS. In this post hoc analysis of the SPRINT-MS trial, we investigate (1) retinal atrophy (2) differences in response by subtype and (3) associations between OCT and MRI measures of neurodegeneration. METHODS In the multicenter, double-blind SPRINT-MS trial, participants with secondary progressive MS (SPMS) or primary progressive MS (PPMS) were randomized to ibudilast or placebo. OCT and MRI data were collected every 24 weeks for 96 weeks. Extensive OCT quality control and algorithmic segmentation produced consistent results across Cirrus HD-OCT and Spectralis devices. Primary endpoints were GCIPL, INL, and ONL atrophy, assessed by linear mixed-effects regression. Secondary endpoints were associations of OCT measures, brain parenchymal fraction, and cortical thickness, assessed by partial Pearson correlations. RESULTS One hundred thirty-four PPMS and 121 SPMS participants were included. GCIPL atrophy was 79% slower in the ibudilast (-0.07 ± 0.23 µm/y) vs placebo group (-0.32 ± 0.20 µm/y, p = 0.003). This effect predominated in the PPMS cohort (ibudilast: -0.08 ± 0.29 µm/y vs placebo: -0.60 ± 0.29 µm/y, a decrease of 87%, p < 0.001) and was not detected in the SPMS cohort (ibudilast: -0.21 ± 0.28 µm/y vs placebo: -0.14 ± 0.27 µm/y, p = 0.55). GCIPL, INL, and ONL atrophy rates correlated with whole brain atrophy rates across the cohort (r = 0.27, r = 0.26, and r = 0.20, respectively; p < 0.001). Power calculations from these data show future trials of similar size and design have ≥80% power to detect GCIPL atrophy effect sizes of approximately 40%. DISCUSSION Ibudilast treatment decreased GCIPL atrophy in PMS, driven by the PPMS cohort, with no effect seen in SPMS. Modulated atrophy of retinal layers may be detectable in sample sizes smaller than the SPRINT-MS trial and correlate with whole brain atrophy in PMS, further highlighting their utility as outcomes in PMS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that ibudilast reduces composite ganglion cell + inner plexiform layer atrophy, without reduction of inner or outer nuclear layer atrophy, in patients with primary progressive MS but not those with secondary progressive MS.
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Affiliation(s)
- Henrik Ehrhardt
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Jeffrey Lambe
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Hussein Moussa
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Eleni S Vasileiou
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Grigorios Kalaitzidis
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Olwen C Murphy
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Angeliki G Filippatou
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Nicole Pellegrini
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Morgan Douglas
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Simidele Davis
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Natalia Nagy
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Agustina Quiroga
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Chen Hu
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Alexandra Zambriczki Lee
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Anna Duval
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Kathryn C Fitzgerald
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Jerry L Prince
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Peter A Calabresi
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Elias S Sotirchos
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Robert Bermel
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH
| | - Shiv Saidha
- From the Department of Neurology (H.E., J.L., H.M., E.S.V., G.K., O.C.M., A.G.F., N.P., M.D., S.D., N.N., A.Q., C.H., A.Z.L., A.D., K.C.F., P.A.C., E.S.S., S.S.), Johns Hopkins University School of Medicine; Department of Electrical and Computer Engineering (J.L.P.), Johns Hopkins University, Baltimore, MD; and Mellen Center for Multiple Sclerosis (R.B.), Cleveland Clinic, OH.
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Chan CK, Beaulieu WT, Lujan BJ, Lalezary M, Lent-Schochet D, Lo T, Yiu G. Impact of Prophylactic Ranibizumab to Prevent Neovascular Age-Related Macular Degeneration on Eyes With Intermediate Age-Related Macular Degeneration. Transl Vis Sci Technol 2023; 12:1. [PMID: 37656449 PMCID: PMC10479187 DOI: 10.1167/tvst.12.9.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/09/2023] [Indexed: 09/02/2023] Open
Abstract
Purpose The purpose of this study was to determine the impact of prophylactic ranibizumab (PR) injections given every 3 months in eyes with intermediate nonexudative age-related macular degeneration (AMD) on drusen volume, macular layer thicknesses, and progression of geographic atrophy (GA) area over 24 months in the PREVENT trial. Methods This post hoc analysis of the prospective PREVENT trial compared eyes with intermediate AMD randomized to PR versus sham injections to determine rates of conversion to neovascular AMD over 24 months. Drusen area and volume, macular thickness and volume, and retinal layer thicknesses were measured on spectral-domain optical coherence tomography images and analyzed. Masked grading of GA area and subretinal drusenoid deposits (SDDs) using fundus autofluorescence images was performed. Results There were no statistical differences in drusen area and volumes between groups, and similar reductions in central subfield thickness, mean cube thickness, cube volume, and retinal sublayer thickness from baseline to 24 months (P = 0.018 to < 0.001), with no statistical differences between groups in any of these anatomic parameters. These findings were not impacted by the presence or absence of SDD. Among the 9 eyes with GA in this study, mean GA growth rate from baseline to 24 months was 1.34 +/- 0.79 mm2/year after PR and 1.95 +/- 1.73 mm2/year in sham-treated eyes (P = 0.49), and similarly showed no statistical difference with square root transformation (P = 0.61). Conclusions Prophylactic ranibizumab given every 3 months did not appear to affect drusen volume, macular thinning, or GA progression in eyes with intermediate AMD. Translational Relevance This work investigates the impact of PR on progressive retinal degeneration in a clinical trial.
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Affiliation(s)
- Clement K. Chan
- Southern California Desert Retina Consultants, Unifeye Vision Partners, Palm Desert, CA, USA
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA, USA
| | | | - Brandon J. Lujan
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- Lujan Imaging LLC, Portland OR, USA
| | | | - Daniella Lent-Schochet
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Therlinder Lo
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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4
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Gernert JA, Böhm L, Starck M, Buchka S, Kümpfel T, Kleiter I, Havla J. Inner Retinal Layer Changes Reflect Changes in Ambulation Score in Patients with Primary Progressive Multiple Sclerosis. Int J Mol Sci 2023; 24:12872. [PMID: 37629053 PMCID: PMC10454007 DOI: 10.3390/ijms241612872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
The establishment of surrogate markers to detect disability progression in persons with multiple sclerosis (PwMS) is important to improve monitoring of clinical deterioration. Optical coherence tomography (OCT) could be such a tool. However, sufficient longitudinal data of retinal neuroaxonal degeneration as a marker of disease progression exist only for PwMS with a relapsing-remitting course (RRMS) so far. In contrast, longitudinal data of retinal layers in patients with primary-progressive MS (PPMS) are inconsistent, and the association of OCT parameters with ambulatory performance in PwMS has rarely been investigated. We aimed to investigate the relative annual rates of change in retinal layers in PwMS (RRMS and PPMS) compared with healthy controls (HC) using OCT and to evaluate their association with ambulatoryfunctionalscore (AS) worsening in PPMS. A retrospective analysis of a longitudinal OCT dataset of the retinal layers of PwMS and HC from two MS centers in Germany was performed. Walking ability was measured over a standardized distance of 500 m, and changes during the observation period were categorized using the AS and the expanded disability status scale (EDSS). 61 HC with 121 eyes and 119 PwMS (PPMS: 57 patients with 108 eyes; RRMS: 62 patients with 114 eyes) were included. The median follow-up time for PwMS was 3 years. The relative annual change of pRNFL (peripapillary retinal nerve fiber layer) and INL (inner nuclear layer) was significantly different in PwMS compared with HC. RRMS and PPMS subgroups did not differ in the annual atrophy rates. In patients with PPMS, worsening of the AS was significantly associated with increased thinning of the TMV (total macular volume), GCIP (ganglion cell and inner plexiform layer), and ONPL (outer nuclear and outer plexiform layer) (all p-value < 0.05, r > 0.30). For every -0.1% decrease in the TMV, GCIP, and ONPL, the risk of a deterioration in the AS increased by 31% (hazard ratio (HR): 1.309), 11% (HR: 1.112), and 16% (HR: 1.161), respectively. In addition, worsening EDSS in PPMS was significantly associated with the relative annual atrophy rates of pRNFL, TMV, and GCIP (all p-value < 0.05). Disability progression in PPMS can be measured using OCT, and increasing annual atrophy rates of the inner retinal layers are associated with worsening ambulation. OCT is a robust and side-effect-free imaging tool, making it suitable for routine monitoring of PwMS.
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Affiliation(s)
- Jonathan A. Gernert
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Luise Böhm
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Michaela Starck
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, 82335 Berg, Germany
| | - Stefan Buchka
- Institute of Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
- Biomedical Center and University Hospital, Ludwig-Maximilians-Universität München, 82152 Planegg-Martinsried, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, 82335 Berg, Germany
- Department of Neurology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
- Biomedical Center and University Hospital, Ludwig-Maximilians-Universität München, 82152 Planegg-Martinsried, Germany
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5
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Ellen O, Ye S, Nheu D, Dass M, Pagnin M, Ozturk E, Theotokis P, Grigoriadis N, Petratos S. The Heterogeneous Multiple Sclerosis Lesion: How Can We Assess and Modify a Degenerating Lesion? Int J Mol Sci 2023; 24:11112. [PMID: 37446290 DOI: 10.3390/ijms241311112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a heterogeneous disease of the central nervous system that is governed by neural tissue loss and dystrophy during its progressive phase, with complex reactive pathological cellular changes. The immune-mediated mechanisms that promulgate the demyelinating lesions during relapses of acute episodes are not characteristic of chronic lesions during progressive MS. This has limited our capacity to target the disease effectively as it evolves within the central nervous system white and gray matter, thereby leaving neurologists without effective options to manage individuals as they transition to a secondary progressive phase. The current review highlights the molecular and cellular sequelae that have been identified as cooperating with and/or contributing to neurodegeneration that characterizes individuals with progressive forms of MS. We emphasize the need for appropriate monitoring via known and novel molecular and imaging biomarkers that can accurately detect and predict progression for the purposes of newly designed clinical trials that can demonstrate the efficacy of neuroprotection and potentially neurorepair. To achieve neurorepair, we focus on the modifications required in the reactive cellular and extracellular milieu in order to enable endogenous cell growth as well as transplanted cells that can integrate and/or renew the degenerative MS plaque.
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Affiliation(s)
- Olivia Ellen
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Sining Ye
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Danica Nheu
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Mary Dass
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Maurice Pagnin
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Ezgi Ozturk
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
| | - Paschalis Theotokis
- Laboratory of Experimental Neurology and Neuroimmunology, Department of Neurology, AHEPA University Hospital, Stilponos Kiriakides Str. 1, 54636 Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, Department of Neurology, AHEPA University Hospital, Stilponos Kiriakides Str. 1, 54636 Thessaloniki, Greece
| | - Steven Petratos
- Department of Neuroscience, Central Clinical School, Monash University, Melborune, VIC 3004, Australia
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Maier S, Barcutean L, Andone S, Manu D, Sarmasan E, Bajko Z, Balasa R. Recent Progress in the Identification of Early Transition Biomarkers from Relapsing-Remitting to Progressive Multiple Sclerosis. Int J Mol Sci 2023; 24:4375. [PMID: 36901807 PMCID: PMC10002756 DOI: 10.3390/ijms24054375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Despite extensive research into the pathophysiology of multiple sclerosis (MS) and recent developments in potent disease-modifying therapies (DMTs), two-thirds of relapsing-remitting MS patients transition to progressive MS (PMS). The main pathogenic mechanism in PMS is represented not by inflammation but by neurodegeneration, which leads to irreversible neurological disability. For this reason, this transition represents a critical factor for the long-term prognosis. Currently, the diagnosis of PMS can only be established retrospectively based on the progressive worsening of the disability over a period of at least 6 months. In some cases, the diagnosis of PMS is delayed for up to 3 years. With the approval of highly effective DMTs, some with proven effects on neurodegeneration, there is an urgent need for reliable biomarkers to identify this transition phase early and to select patients at a high risk of conversion to PMS. The purpose of this review is to discuss the progress made in the last decade in an attempt to find such a biomarker in the molecular field (serum and cerebrospinal fluid) between the magnetic resonance imaging parameters and optical coherence tomography measures.
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Affiliation(s)
- Smaranda Maier
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Laura Barcutean
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Doina Manu
- Center for Advanced Medical and Pharmaceutical Research, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Emanuela Sarmasan
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Rodica Balasa
- Ist Neurology Clinic, Emergency Clinical County Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
- Doctoral School, ‘George Emil Palade’ University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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7
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Bayas A, Christ M, Faissner S, Klehmet J, Pul R, Skripuletz T, Meuth SG. Disease-modifying therapies for relapsing/active secondary progressive multiple sclerosis - a review of population-specific evidence from randomized clinical trials. Ther Adv Neurol Disord 2023; 16:17562864221146836. [PMID: 36710720 PMCID: PMC9880589 DOI: 10.1177/17562864221146836] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/04/2022] [Indexed: 01/25/2023] Open
Abstract
Although the understanding of secondary progressive multiple sclerosis (SPMS) is evolving, early detection of relapse-independent progression remains difficult. This is further complicated by superimposed relapses and compensatory mechanisms that allow for silent progression. The term relapsing multiple sclerosis (RMS) subsumes relapsing-remitting multiple sclerosis (RRMS) and SPMS with relapses. The latter is termed 'active' SPMS, for which disease-modifying therapies (DMTs) approved for either RMS or active SPMS can be used. However, the level of evidence supporting efficacy and safety in SPMS differs between drugs approved for RMS and SPMS. Our review aims to identify current evidence from published clinical trials and European public assessment reports from the marketing authorization procedure on the efficacy, especially on progression, of DMTs approved for RMS and SPMS. To identify relevant evidence, a literature search has been conducted and European public assessment reports of DMTs approved for RMS have been screened for unpublished data specific to SPMS. Only two clinical trials demonstrated a significant reduction in disability progression in SPMS study populations: the EXPAND study for siponimod, which included a typical SPMS population, and the European study for interferon (IFN)-beta 1b s.c., which included patients with very early and active SPMS. Both DMTs also achieved significant reductions in relapse rates. Ocrelizumab, cladribine, ofatumumab, and ponesimod are all approved for RMS - ocrelizumab, ofatumumab, and ponesimod based on an RMS study, cladribine based on an RRMS study. Data on efficacy in SPMS are only available from post hoc analyses of very small subgroups, representing only up to 15% of the total study population. For these DMTs, approval for RMS, including active SPMS, was mainly based on the assumption that the reduction in relapse rate observed in patients with RRMS can also be applied to SPMS. Based on that, the potential of these drugs to reduce relapse-independent progression remains unclear.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology, Faculty of Medicine,
University of Augsburg, Augsburg, Germany
| | - Monika Christ
- Department of Neurology, Faculty of Medicine,
University of Augsburg, Augsburg, Germany
| | - Simon Faissner
- Department of Neurology, St. Josef-Hospital,
Ruhr-University Bochum, Bochum, Germany
| | - Juliane Klehmet
- Department of Neurology, Jüdisches Krankenhaus
Berlin, Berlin, Germany
| | - Refik Pul
- Department of Neurology and Center for
Translational and Behavioral Neurosciences (C-TNBS), University Medicine
Essen, Essen, Germany
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8
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Silva R, Coelho P, Seabra M, Laranjinha I, Vieira D, Costa O, Jesus J, Fonseca AC, Costa S, Ferreira I, Lemos J, Sousa C, Vale J, Sá MJ, Ruano L. Cognitive impairment and markers of optical neurodegeneration in early multiple sclerosis. Neurol Sci 2022; 43:4381-4386. [DOI: 10.1007/s10072-022-05945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
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9
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Rube J, Bross M, Bernitsas C, Hackett M, Bao F, Bernitsas E. Effect of Obesity on Retinal Integrity in African Americans and Caucasian Americans With Relapsing Multiple Sclerosis. Front Neurol 2021; 12:743592. [PMID: 34899566 PMCID: PMC8651698 DOI: 10.3389/fneur.2021.743592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: To study the effect of obesity on retinal structures in African Americans (AAs) and Caucasian Americans (CAs) with relapsing-remitting multiple sclerosis (RRMS). Methodology: About 136 patients with RRMS without history of optic neuritis were divided into two groups, based on body mass index (BMI): 67 obese (40 AA, 27 CA, mean BMI ± SD: 36.7 ± 5.8), and 69 non-obese (23 AA, 46 CA, mean BMI ± SD: 24.0 ± 3.1). The peripapillary retinal nerve fiber layer (pRNFL) thickness was quantified by optical coherence tomography (OCT) and was segmented into quadrant thickness: superior (S), inferior (I), temporal (T), and nasal (N). Papillomacular bundle (PMB) thickness, retinal nerve fiber layer (RNFL), ganglion cell + inner plexiform layer (GCIPL), inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and total macular (TMV) volumes were obtained. Results: Obesity was associated with lower T thickness (58.54 ± 15.2 vs. 61.9 12.4, p = 0.044), higher INL (0.98 ± 0.07 vs. 0.96 ± 0.06, p = 0.034), and lower RNFL (0.77 ± 0.14 vs. 0.82 ± 0.12, p = 0.009) volumes. Obese AA had significantly thinner T (58.54 ± 15.19 vs. 61.91 ± 12.39, p = 0.033), N (68.94 ± 2.7 vs. 77.94 ± 3.3, p = 0.044), and TMV (8.15 ± 0.07 vs. 8.52 ± 0.09, p = 0.003), RNFL (0.74 ± 0.02 vs. 0.82 ± 0.02, p = 0.013), OPL (0.76 ± 0.01 vs. 0.79 ± 0.1, p = 0.050), ONL (1.68 ± 0.031 vs. 1.79 ± 0.038, p = 0.026), and GCIPL (1.78 ± 0.04 vs. 1.9 ± 0.05, p = 0.038) compared to obese CA. Among patients with non-obesity, the ONL was significantly lower in AA (1.78 ± 0.04 vs. 1.9 ± 0.05, p < 0.001). Conclusions: Obesity is associated with retinal structure abnormalities in patients with RRMS. Its impact might be more prominent in AA than CA. Large longitudinal studies are needed to validate our findings.
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Affiliation(s)
- Jacob Rube
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States
| | - Madeline Bross
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States
| | | | - Melody Hackett
- PPD Regional, Clinical Operations, Detroit, MI, United States
| | - Fen Bao
- Wayne State University Imaging Laboratory and Sastry Foundation Imaging Initiative, Detroit, MI, United States
| | - Evanthia Bernitsas
- Wayne State University School of Medicine and University Health Center, Detroit, MI, United States.,Wayne State University Imaging Laboratory and Sastry Foundation Imaging Initiative, Detroit, MI, United States
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10
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Guerrieri S, Comi G, Leocani L. Optical Coherence Tomography and Visual Evoked Potentials as Prognostic and Monitoring Tools in Progressive Multiple Sclerosis. Front Neurosci 2021; 15:692599. [PMID: 34421520 PMCID: PMC8374170 DOI: 10.3389/fnins.2021.692599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Understanding the mechanisms underlying progression and developing new treatments for progressive multiple sclerosis (PMS) are among the major challenges in the field of central nervous system (CNS) demyelinating diseases. Over the last 10 years, also because of some technological advances, the visual pathways have emerged as a useful platform to study the processes of demyelination/remyelination and their relationship with axonal degeneration/protection. The wider availability and technological advances in optical coherence tomography (OCT) have allowed to add information on structural neuroretinal changes, in addition to functional information provided by visual evoked potentials (VEPs). The present review will address the role of the visual pathway as a platform to assess functional and structural damage in MS, focusing in particular on the role of VEPs and OCT, alone or in combination, in the prognosis and monitoring of PMS.
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Affiliation(s)
- Simone Guerrieri
- Experimental Neurophysiology Unit, San Raffaele Hospital, Institute of Experimental Neurology (INSPE), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Vita-Salute San Raffaele University, Milan, Italy.,Casa di Cura del Policlinico, Milan, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, San Raffaele Hospital, Institute of Experimental Neurology (INSPE), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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11
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Abstract
Multiple sclerosis (MS) is a neurological inflammatory disorder known to attack the heavily myelinated regions of the nervous system including the optic nerves, cerebellum, brainstem and spinal cord. This review will discuss the clinical manifestations and investigations for MS and other similar neurological inflammatory disorders affecting vision, as well as the effects of MS treatments on vision. Assessment of visual pathways is critical, considering MS can involve multiple components of the visual pathway, including optic nerves, uvea, retina and occipital cortex. Optical coherence tomography is increasingly being recognised as a highly sensitive tool in detecting subclinical optic nerve changes. Magnetic resonance imaging (MRI) is critical in MS diagnosis and in predicting long-term disability. Optic neuritis in MS involves unilateral vision loss, with characteristic pain on eye movement. The visual loss in neuromyelitis optica spectrum disorder tends to be more severe with preferential altitudinal field loss, chiasmal and tract lesions are also more common. Other differential diagnoses include chronic relapsing inflammatory optic neuropathy and giant cell arteritis. Leber's hereditary optic neuropathy affects young males and visual loss tends to be painless and subacute, typically involving both optic nerves. MS lesions in the vestibulocerebellum, brainstem, thalamus and basal ganglia may lead to abnormalities of gaze, saccades, pursuit and nystagmus which can be identified on eye examination. Medial longitudinal fasciculus lesions can cause another frequent presentation of MS, internuclear ophthalmoplegia, with failure of ipsilateral eye adduction and contralateral eye abduction nystagmus. Treatments for MS include high-dose corticosteroids for acute relapses and disease-modifying medications for relapse prevention. These therapies may also have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular oedema with fingolimod.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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12
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Evaluation of Retinal Structure and Optic Nerve Function Changes in Multiple Sclerosis: Longitudinal Study with 1-Year Follow-Up. Neurol Res Int 2021; 2021:5573839. [PMID: 34221503 PMCID: PMC8225456 DOI: 10.1155/2021/5573839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune disease characterized by inflammation and demyelination of the central nervous system which often involves the optic nerve even though only 20% of the patients experience optic neuritis (ON). Objective This study aims to compare the retinal structure and optic nerve function between patients with MS and healthy controls (HCs), evaluate optic nerve alterations in MS over 1-year follow-up, and analyze its correlations with disease duration, number of relapses, degree of disability, and different subtypes. Methods This is a prospective cohort study involving 58 eyes of MS patients. Optic nerve function was evaluated with best-corrected visual acuity (BCVA), contrast sensitivity, and P100 latency, while the retinal structure was evaluated from the GCIPL and RNFL thickness measured with optical coherence tomography (OCT) and fundus photography. Results The MS group had lower BCVA (p=0.001), contrast sensitivity (p < 0.001), mean GCIPL thickness (p < 0.001), and mean RNFL thickness (p < 0.001) than HC. At 6 and 12 months of observations, GCIPL and RNFL (nasal quadrant) of MS patients decreased significantly (p=0.007 and p=0.004, respectively). Disease duration and the number of relapses correlated with delayed P100 latency (r = −0.61, p < 0.001 and r = −0.46, p=0.02). GCIPL and RNFL in the SPMS subtype were thinner than in RRMS. Conclusions The retinal structure and optic nerve function of MS patients are worse than those of normal individuals. GCIPL and RNFL thinning occurs at 6 and 12 months but do not correlate with disease duration, the number of relapses, and degree of disability.
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13
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Seitz CB, Steffen F, Muthuraman M, Uphaus T, Krämer J, Meuth SG, Albrecht P, Groppa S, Zipp F, Bittner S, Fleischer V. Serum neurofilament levels reflect outer retinal layer changes in multiple sclerosis. Ther Adv Neurol Disord 2021; 14:17562864211003478. [PMID: 34104217 PMCID: PMC8155762 DOI: 10.1177/17562864211003478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Serum neurofilament light chain (sNfL) and distinct intra-retinal layers are
both promising biomarkers of neuro-axonal injury in multiple sclerosis (MS).
We aimed to unravel the association of both markers in early MS, having
identified that neurofilament has a distinct immunohistochemical expression
pattern among intra-retinal layers. Methods: Three-dimensional (3D) spectral domain macular optical coherence tomography
scans and sNfL levels were investigated in 156 early MS patients
(female/male: 109/47, mean age: 33.3 ± 9.5 years, mean disease duration:
2.0 ± 3.3 years). Out of the whole cohort, 110 patients had no history of
optic neuritis (NHON) and 46 patients had a previous history of optic
neuritis (HON). In addition, a subgroup of patients
(n = 38) was studied longitudinally over 2 years. Support
vector machine analysis was applied to test a regression model for
significant changes. Results: In our cohort, HON patients had a thinner outer plexiform layer (OPL) volume
compared to NHON patients (B = −0.016, SE = 0.006,
p = 0.013). Higher sNfL levels were significantly
associated with thinner OPL volumes in HON patients
(B = −6.734, SE = 2.514, p = 0.011). This
finding was corroborated in the longitudinal subanalysis by the association
of higher sNfL levels with OPL atrophy (B = 5.974,
SE = 2.420, p = 0.019). sNfL levels were 75.7% accurate at
predicting OPL volume in the supervised machine learning. Conclusions: In summary, sNfL levels were a good predictor of future outer retinal
thinning in MS. Changes within the neurofilament-rich OPL could be
considered as an additional retinal marker linked to MS
neurodegeneration.
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Affiliation(s)
- Caspar B Seitz
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Krämer
- Department of Neurology with Institute of Translational Neurology, University of Münster, Albert-Schweizer-Campus, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University of Münster, Albert-Schweizer-Campus, Münster, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany
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14
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Filippi M, Preziosa P, Barkhof F, Chard DT, De Stefano N, Fox RJ, Gasperini C, Kappos L, Montalban X, Moraal B, Reich DS, Rovira À, Toosy AT, Traboulsee A, Weinshenker BG, Zeydan B, Banwell BL, Rocca MA. Diagnosis of Progressive Multiple Sclerosis From the Imaging Perspective: A Review. JAMA Neurol 2021; 78:351-364. [PMID: 33315071 PMCID: PMC11382596 DOI: 10.1001/jamaneurol.2020.4689] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Although magnetic resonance imaging (MRI) is useful for monitoring disease dissemination in space and over time and excluding multiple sclerosis (MS) mimics, there has been less application of MRI to progressive MS, including diagnosing primary progressive (PP) MS and identifying patients with relapsing-remitting (RR) MS who are at risk of developing secondary progressive (SP) MS. This review addresses clinical application of MRI for both diagnosis and prognosis of progressive MS. Observations Although nonspecific, some spinal cord imaging features (diffuse abnormalities and lesions involving gray matter [GM] and ≥2 white matter columns) are typical of PPMS. In patients with PPMS and those with relapse-onset MS, location of lesions in critical central nervous system regions (spinal cord, infratentorial regions, and GM) and MRI-detected high inflammatory activity in the first years after diagnosis are risk factors for long-term disability and future progressive disease course. These measures are evaluable in clinical practice. In patients with established MS, GM involvement and neurodegeneration are associated with accelerated clinical worsening. Subpial demyelination and slowly expanding lesions are novel indicators of progressive MS. Conclusions and Relevance Diagnosis of PPMS is more challenging than diagnosis of RRMS. No qualitative clinical, immunological, histopathological, or neuroimaging features differentiate PPMS and SPMS; both are characterized by imaging findings reflecting neurodegeneration and are also impacted by aging and comorbidities. Unmet diagnostic needs include identification of MRI markers capable of distinguishing PPMS from RRMS and predicting the evolution of RRMS to SPMS. Integration of multiple parameters will likely be essential to achieve these aims.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e di Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e di Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location VU University Medical Center (VUmc), Multiple Sclerosis Center Amsterdam, Amsterdam, the Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Declan T Chard
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, United Kingdom
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, United Kingdom
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Department of Neurology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location VU University Medical Center (VUmc), Multiple Sclerosis Center Amsterdam, Amsterdam, the Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology (IDI), Vall d'Hebron University Hospital and Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Ahmed T Toosy
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, United Kingdom
| | - Anthony Traboulsee
- MS/Magnetic Resonance Imaging (MRI) Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Burcu Zeydan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Istituto di Ricovero e di Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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15
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Deverdun J, Coget A, Ayrignac X, Carra-Dalliere C, Krainik A, Metzger A, Labauge P, Menjot de Champfleur N, Le Bars E. Cerebral Vasoreactivity as an Indirect MRI Marker of White Matter Tracts Alterations in Multiple Sclerosis. Brain Topogr 2021; 34:245-255. [PMID: 33484378 DOI: 10.1007/s10548-021-00819-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/06/2021] [Indexed: 02/02/2023]
Abstract
Patients with multiple sclerosis (MS) show a diffuse cerebral perfusion decrease, presumably related to multiple metabolism and vascular alterations. It is assumed that white matter fiber alterations cause a localized cerebral vasoreactivity (CVR) disruption through astrocytes metabolism alteration, leading to hypoperfusion. We proposed to (1) evaluate the CVR disruptions in MS, (2) in relation to white matter lesions and (3) compare CVR disruptions maps with standard imaging biomarkers. Thirty-five MS patients (10 progressive, 25 relapsing-remitting) and 22 controls underwent MRI with hypercapnic challenge, DTI imaging and neuropsychological assessment. Areas with disrupted CVR were assessed using a general linear model. Resulting maps were associated with clinical scores, compared between groups, and related to DTI metrics and white matter lesions. MS patients showed stronger disrupted CVR within supratentorial white matter, linking the left anterior insula to both the precentral gyrus and the right middle and superior frontal gyrus through the corpus callosum (P < 0.05, FWE corrected). Patient's verbal intellectual quotient was negatively associated with a pathway linking both hippocampi to the ispilateral prefrontal cortex (P < 0.05, FWE corrected). Disrupted CVR maps unrelated to DTI metrics and white matter lesions. We have demonstrated for the first time that white matter alterations can be indirectly identified through surrounding vessel alterations, and are related to clinical signs of MS. This offers a new, likely independent marker to monitor MS and supports a mediator role of the astrocytes in the fibers/vessels relationship.
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Affiliation(s)
- Jeremy Deverdun
- Department of Neuroradiology, University Hospital Center, I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Cedex 5, Montpellier, France.
| | - Arthur Coget
- Department of Neuroradiology, University Hospital Center, I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Cedex 5, Montpellier, France
- Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
- Laboratoire Charles Coulomb, University of Montpellier, 34095, Montpellier, France
| | - Xavier Ayrignac
- Department of Neurology, MS Center and National Reference Center of Adult Leukodystrophies, Montpellier University Hospital, 34 295 Cedex 5, Montpellier, France
| | - Clarisse Carra-Dalliere
- Department of Neurology, MS Center and National Reference Center of Adult Leukodystrophies, Montpellier University Hospital, 34 295 Cedex 5, Montpellier, France
| | - Alexandre Krainik
- Department of Neuroradiology and MRI, Grenoble Institute of Neurosciences, INSERM U836, UMS IRMaGe, Grenoble University Hospital, University Grenoble Alps, Grenoble, France
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France
| | - Aude Metzger
- Department of neuro -ophthalmology and neuro cognition, Pierre Wertheimer University Hospital, 69500, Bron, France
| | - Pierre Labauge
- Department of Neurology, MS Center and National Reference Center of Adult Leukodystrophies, Montpellier University Hospital, 34 295 Cedex 5, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Department of Neuroradiology, University Hospital Center, I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Cedex 5, Montpellier, France
- Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", INSERM U1051, Institute of Neurosciences of Montpellier, Montpellier, France
- Laboratoire Charles Coulomb, University of Montpellier, 34095, Montpellier, France
| | - Emmanuelle Le Bars
- Department of Neuroradiology, University Hospital Center, I2FH, Institut d'Imagerie Fonctionnelle Humaine, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34295 Cedex 5, Montpellier, France
- Department of Neuroradiology, Montpellier University Hospital, Gui de Chauliac Hospital, Montpellier, France
- Laboratoire Charles Coulomb, University of Montpellier, 34095, Montpellier, France
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Chiang TTK, Keenan TD, Agrón E, Liao J, Klein B, Chew EY, Cukras CA, Wong WT. Macular Thickness in Intermediate Age-Related Macular Degeneration Is Influenced by Disease Severity and Subretinal Drusenoid Deposit Presence. Invest Ophthalmol Vis Sci 2021; 61:59. [PMID: 32602904 PMCID: PMC7415904 DOI: 10.1167/iovs.61.6.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate how macular thickness varies with intermediate age-related macular degeneration (iAMD) severity and the presence of subretinal drusenoid deposits (SDDs). Methods A longitudinal prospective study of 143 participants >50 years of age with no to intermediate AMD who were followed with multimodal imaging and functional testing. Participants were stratified by iAMD severity according to imaging features. Macular thicknesses measurements over the central circles with 1-mm, 3-mm, and 6-mm diameters obtained from ocular coherence tomography imaging were compared across severity categories using cross-sectional (143 eyes) and longitudinal (subset of 77 eyes followed for 4 years) multivariate analyses. Results Compared with control eyes without large drusen or SDDs (Group 0), central maculas of lower risk eyes with unilateral large drusen (Group 1) were thicker (P = 0.014), whereas higher risk eyes with SDDs (Group SDD) were thinner (P = 0.02) in cross-sectional multivariate analyses. In longitudinal analyses, maculas with SDDs thinned more rapidly over 4 years relative to control eyes (P = 0.0058), which did not show significant thinning. More rapid central macular thinning was associated with worse baseline best-corrected visual acuity (BCVA) (P = 0.016) and more rapid BCVA decline (P = 0.0059). Conclusions Macular thickness in iAMD varies with disease severity, showing small increases in eyes with large drusen and decreases in eyes with SDDs. Active processes possibly related to neuroinflammation and neurodegeneration may be contributory. Longitudinal central macular thickness evaluation is an accessible outcome measure relevant to functional measures and is potentially useful for iAMD interventional studies.
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17
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Garcia-Martin E, Ortiz M, Boquete L, Sánchez-Morla EM, Barea R, Cavaliere C, Vilades E, Orduna E, Rodrigo MJ. Early diagnosis of multiple sclerosis by OCT analysis using Cohen's d method and a neural network as classifier. Comput Biol Med 2020; 129:104165. [PMID: 33302162 DOI: 10.1016/j.compbiomed.2020.104165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The consequences of inflammation, demyelination, axonal degeneration and neuronal loss in the central nervous system, typical of the development of multiple sclerosis (MS), are manifested in thinning of the retina and optic nerve. The purpose of this work is to diagnose early-stage MS patients based on analysis of retinal layer thickness obtained by swept-source optical coherence tomography (SS-OCT). METHOD OCT (Triton® SS-OCT device -Topcon, Tokyo, Japan-) recordings were obtained from 48 control subjects and 48 recently diagnosed MS patients. The following thicknesses were measured on a 45 × 60 grid: retinal nerve fibre layer (RNFL), ganglion cell layer (GCL+), GCL++, retinal thickness and choroid. Using Cohen's d effect size, it was determined the regions and layers with greatest capacity to discriminate between control subjects and patients. Points exceeding the threshold set were used as inputs for an automatic classifier: support vector machine and feed-forward neural network. RESULTS In MS at clinical onset the layer with greatest discriminant capacity is GCL++ [AUC = 0.83] which exhibits a horseshoe-like macular topographic distribution. It is followed by retina, GCL+ and RNFL; choroidal thicknesses do not provide discriminatory capacity. Using a neural network as a classifier between controls and MS patients, obtains sensitivity of 0.98 and specificity of 0.98. CONCLUSIONS This work suggest that OCT may serve as an important complementary role to other clinical tests, particularly regarding neurodegeneration. It is possible to characterise structural alterations in retina and diagnose early-stage MS with high degree of accuracy using OCT and artificial neural networks.
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Affiliation(s)
- E Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain; RETICS: Thematic Networks for Co-operative Research in Health for Ocular Diseases, Spain
| | - M Ortiz
- School of Physics, University of Melbourne, VIC, 3010, Australia
| | - L Boquete
- RETICS: Thematic Networks for Co-operative Research in Health for Ocular Diseases, Spain; Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - E M Sánchez-Morla
- Department of Psychiatry, Hospital 12 de Octubre Research Institute (i+12), 28041, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, 28040, Madrid, Spain; CIBERSAM: Biomedical Research Networking Centre in Mental Health, 28029, Madrid, Spain
| | - R Barea
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - C Cavaliere
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - E Vilades
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain
| | - E Orduna
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain
| | - M J Rodrigo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain; RETICS: Thematic Networks for Co-operative Research in Health for Ocular Diseases, Spain.
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18
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Ziccardi L, Barbano L, Boffa L, Albanese M, Grzybowski A, Centonze D, Parisi V. Morphological Outer Retina Findings in Multiple Sclerosis Patients With or Without Optic Neuritis. Front Neurol 2020; 11:858. [PMID: 33041959 PMCID: PMC7522220 DOI: 10.3389/fneur.2020.00858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Lucia Ziccardi
- Istituto di Ricovero e Cura a Carattere Scientifico - Fondazione Bietti, Rome, Italy
| | - Lucilla Barbano
- Istituto di Ricovero e Cura a Carattere Scientifico - Fondazione Bietti, Rome, Italy
| | - Laura Boffa
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Maria Albanese
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Diego Centonze
- Unit of Neurology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Neuromed - Unit of Neurology and Neurorehabilitation, Pozzilli, Italy
| | - Vincenzo Parisi
- Istituto di Ricovero e Cura a Carattere Scientifico - Fondazione Bietti, Rome, Italy
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19
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Tavazzi E, Jakimovski D, Kuhle J, Hagemeier J, Ozel O, Ramanathan M, Barro C, Bergsland N, Tomic D, Kropshofer H, Leppert D, Michalak Z, Lincoff N, Dwyer MG, Benedict RHB, Weinstock-Guttman B, Zivadinov R. Serum neurofilament light chain and optical coherence tomography measures in MS: A longitudinal study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/4/e737. [PMID: 32424064 PMCID: PMC7251512 DOI: 10.1212/nxi.0000000000000737] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To study the association between serum neurofilament light chain (sNfL) and multiple optical coherence tomography (OCT) measures in patients with MS and healthy controls (HCs). METHODS In this prospective study, 110 patients with MS were recruited, together with 52 age- and sex-matched HCs. Clinical evaluation and spectral domain OCT and sNfL were obtained at baseline and after 5.5 years of follow-up. Nested linear mixed models were used to assess differences between MS vs HC and associations between sNfL and OCT measures. Partial correlation coefficients are reported, and p values were adjusted for the false discovery rate. RESULTS At baseline, peripapillary retinal nerve fiber layer thickness (pRNFLT) and macular ganglion cell and inner plexiform layer thickness (mGCIP) were significantly lower in MS than HC both in MS-associated optic neuritis (MSON) (p = 0.007, p = 0.001) and nonaffected MSON (n-MSON) eyes (p = 0.003, p = 0.018), along with total macular volume (TMV) in n-MSON eyes (p = 0.011). At follow-up, MS showed significantly lower pRNFLT, mGCIP, and TMV both in MSON and n-MSON eyes (p < 0.001) compared with HC. In MS n-MSON eyes, sNfL was significantly associated with baseline pRNFLT and mGCIP (q = 0.019). No significant associations were found in MSON eyes. CONCLUSIONS This study confirms the ability of sNfL to detect neurodegeneration in MS and advocates for the inclusion of sNfL and OCT measures in clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that sNfL levels were associated with MS neurodegeneration measured by OCT.
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Affiliation(s)
- Eleonora Tavazzi
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Dejan Jakimovski
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Jens Kuhle
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Jesper Hagemeier
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Osman Ozel
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Murali Ramanathan
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Christian Barro
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Niels Bergsland
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Davorka Tomic
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Harald Kropshofer
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - David Leppert
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Zuzanna Michalak
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Norah Lincoff
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Michael G Dwyer
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Ralph H B Benedict
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Bianca Weinstock-Guttman
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York
| | - Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Center (E.T., D.J., J.H., O.O., N.B., M.G.D., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; IRCCS (N.B.), Fondazione Don Carlo Gnocchi, Milan, Italy; Neurologic Clinic and Policlinic (J.K., C.B., Z.M., N.L.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland; Department of Pharmaceutical Sciences (M.R.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York; Novartis Pharma AG (D.T., H.K., D.L.), Basel, Switzerland; Jacobs MS Center (R.H.B.B., B.W.-G.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York.
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20
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Lee G, Park K, Son G, Kong D, Oh SY. Optical coherence tomography analysis of inner and outer retinal layers in eyes with chiasmal compression caused by suprasellar tumours. Acta Ophthalmol 2020; 98:e373-e380. [PMID: 31602819 DOI: 10.1111/aos.14271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/14/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare postoperative macular thickness measurements of inner and outer retinal layers in eyes of patients with chiasmal compression with or without visual field (VF) recovery and healthy controls using optical coherence tomography (OCT). METHODS Macular spectral-domain OCT has been used for the auto-segmentation of images obtained from 100 eyes affected with chiasmal compression compared with 100 healthy controls enrolled in this study. We have divided eyes with chiasmal compression into two groups: group 1 characterized by VF recovery after tumour excision and group 2 showing partial or no recovery of VF. The thickness of the macular retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer (PRL), inner retinal layer (IRL) and outer retinal layer (ORL) was segmented. The correlation between macular RNFL (mRNFL) and functional parameters has been analysed. RESULTS Both groups 1 and 2 showed significant thinning of RNFL, GCL, IPL and IRL in all quadrants. However, no significant changes have been detected in PRL and ORL of patients in either group compared with healthy controls. A significant thickening was detected in INL and ONL of group 2 compared with healthy controls and group 1. Postoperative mRNFL thickness is significantly correlated with VF defects and visual acuity except temporal quadrant. CONCLUSIONS Eyes with chiasmal compression showed thinning of the inner retinal layers with thickening of the INL and ONL in patients with partial to no recovery of VF. The changes in retinal microstructures are well-correlated with functional recovery. Further studies are needed to reveal the clinical implications of these findings in patients with chiasmal compression.
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Affiliation(s)
- Ga‐In Lee
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Kyung‐Ah Park
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Giyoung Son
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Doo‐Sik Kong
- Department of Neurosurgery Endoscopic Skull Base Surgery Clinic Brain Tumor Center Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sei Yeul Oh
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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21
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Airen S, Shi C, Liu Z, Levin BE, Signorile JF, Wang J, Jiang H. Focal alteration of the intraretinal layers in neurodegenerative disorders. ACTA ACUST UNITED AC 2020; 5. [PMID: 32939442 DOI: 10.21037/aes.2019.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Focal intraretinal alterations have been studied to advance our understanding of the pathology of neurodegenerative diseases. The current literature involving focal alterations in the intraretinal layers was reviewed through PubMed using the search terms "focal alteration", "region of interest", "optical coherence tomography", "glaucoma", "multiple sclerosis", "Alzheimer's disease", "Parkinson disease", "neurodegenerative diseases" and other related items. It was found that focal alterations of intraretinal layers were different in various neurodegenerative diseases. The typical focal thinning might help differentiate various ocular and cerebral diseases, track disease progression, and evaluate the outcome of clinical trials. Advanced exploration of focal intraretinal alterations will help to further validate their clinical and research utility.
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Affiliation(s)
- Shriya Airen
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ce Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhiping Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
| | - Bonnie E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joseph F Signorile
- Department of Kinesiology and Sports Sciences, University of Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Hu H, Jiang H, Gameiro GR, Hernandez J, Delgado S, Wang J. Focal Thickness Reduction of the Ganglion Cell-Inner Plexiform Layer Best Discriminates Prior Optic Neuritis in Patients With Multiple Sclerosis. Invest Ophthalmol Vis Sci 2020; 60:4257-4269. [PMID: 31618762 PMCID: PMC6996667 DOI: 10.1167/iovs.19-27574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The goal was to visualize topographic thickness maps of the intraretinal layers and evaluate their discrimination abilities and relationships with clinical manifestations in patients with multiple sclerosis (MS) and a history of optic neuritis (ON). Methods Thirty patients with relapsing-remitting MS (34 eyes with a history of ON [MSON] and 26 non-ON fellow eyes [MSFE]) were recruited together with 63 age- and sex-matched controls (HC). Ultrahigh resolution optical coherence tomography was used to image the macula and the volumetric data set was segmented to yield six intraretinal layers. Topographic thickness maps were aligned and averaged for the visualization. The thickness maps were partitioned using the Early Treatment Diabetic Retinopathy Study (ETDRS) and related to Sloan low-contrast letter acuity (LCLA), Expanded Disability Status Scale (EDSS), and disease duration. Results Focal thickness reduction occurred in the macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GCIPL), with the most profound reduction occurring in MSON eyes (P < 0.05). A horseshoe-like thickness reduction pattern (U Zone) in the GCIPL appeared in MSON. The thickness of the U Zone had better discrimination power than the ETDRS partitions (area under the curve = 0.97) and differentiated 96% of MSON from HC. The thickness of the U Zone was positively correlated to 2.5% LCLA (r = 0.38, P < 0.05) and 1.25% LCLA (r = 0.57, P < 0.05). Conclusions The horseshoe-like thickness reduction of the GCIPL appeared to be an ON-specific focal thickness alteration with the highest discrimination power of prior ON.
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Affiliation(s)
- Huiling Hu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovana Rosa Gameiro
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jeffrey Hernandez
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Silvia Delgado
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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23
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Eslami F, Ghiasian M, Khanlarzade E, Moradi E. Retinal Nerve Fiber Layer Thickness and Total Macular Volume in Multiple Sclerosis Subtypes and Their Relationship with Severity of Disease, a Cross-Sectional Study. Eye Brain 2020; 12:15-23. [PMID: 32021529 PMCID: PMC6974299 DOI: 10.2147/eb.s229814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/25/2019] [Indexed: 01/27/2023] Open
Abstract
Background Optic neuritis (ON) is an inflammatory demyelinating lesion in the optic nerve, which is strongly associated with multiple sclerosis (MS). Optical coherence tomography (OCT) is a noninvasive technique for the evaluation of the retinal layers. Our aim was to examine OCT metrics including retinal nerve fiber layer thickness (RNFLT), and total macular volume (TMV), in MS subtypes and their relationship with duration, first manifestation, and severity of disease. Material and Methods In this cross-sectional study, patients with a definite diagnosis of MS underwent complete ophthalmic and neurologic examination. OCT parameters including TMV and RNFLT were compared between MS subtypes and different first manifestations of MS. Their relationships were also studied with the duration and severity of disease based on the Expanded Disability Status Scale (EDSS) score. Results A total of 240 eyes were examined in 120 enrolled MS patients. The differences in RNFLT were not analytically meaningful between the subtypes of MS, but the differences in TMV values were statistically significant between the subtypes of MS (P: 0.39 and P: 0.04, respectively). The differences between RNFLT and TMV of eyes with and without ON were statistically significant between these two groups (P<0.001 and P<0.001). There was also an inverse correlation between EDSS disability score and RNFLT and TMV values (P: 0.00, r: −0.33 and P: 0.034, r: −0.11, respectively) and a significant inverse correlation between the duration of MS and RNFLT (P: 0.00, r: −0.47). The differences in RNFLT and TMV values were analytically meaningful between the categories of first manifestations of MS (P: 0.000 and P: 0.027, respectively). Conclusion RNFLT and TMV represent noninvasive parameters for assessment of neuroaxonal degeneration in the anterior visual pathway that correlate with the severity and duration of multiple sclerosis. The lowest RNFLT and TMV values were also seen in the perceptual category between the first manifestations of MS. Therefore, they may be useful in the evaluation of MS patients.
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Affiliation(s)
- Fatemeh Eslami
- Department of Ophthalmology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Ghiasian
- Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elham Khanlarzade
- Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ehsan Moradi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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24
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Increased Levels of Endothelin-1 in Cerebrospinal Fluid Are a Marker of Poor Visual Recovery after Optic Neuritis in Multiple Sclerosis Patients. DISEASE MARKERS 2019; 2019:9320791. [PMID: 31583031 PMCID: PMC6754925 DOI: 10.1155/2019/9320791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/08/2019] [Accepted: 08/30/2019] [Indexed: 01/28/2023]
Abstract
Background Multiple sclerosis (MS), a chronic inflammatory and degenerative disease of the central nervous system, typically features immune-mediated focal demyelination and secondary axonal degeneration. Cerebral hypoperfusion of the normal-appearing white matter (NAWM) has been reported in MS patients and may be mediated by elevated levels of endothelin-1 (ET-1), a most potent vasoconstrictive peptide released from reactive astrocytes in MS focal lesions. Optic neuritis (ON) is one of the most frequent manifestations of MS and also shows peripapillary vascular hypoperfusion in combination with disc swelling. Aims We aimed to compare serum and cerebrospinal fluid (CSF) levels of ET-1 as a potential prognostic marker of MS-ON in two groups of patients differing for severity of MS-ON clinical presentation. Materials and Methods A cross-sectional study to compare serum and CSF levels of ET-1 between patients with clinically aggressive MS-ON (A-MS-ON) and nonaggressive MS-ON (NA-MS-ON) according to conventional ophthalmological criteria, including optical coherence tomography. CSF and serum concentrations of ET-1 were measured using a commercially available ELISA method. Results Sixteen patients consecutively referred to the Units of Neurology for visual disturbances attributable to MS were recruited, 11 (69%) patients with A-MS-ON and 5 (31%) with NA-MS-ON. Median CSF ET-1 levels and CSF/serum ET-1 quotient were significantly higher in patients with A-MS-ON (0.30 vs. 0.56 ng/ml) as compared to NA-MS-ON (0.16 vs. 0.16). Conclusions Severity and failure in the recovery from ON in MS patients may depend from vascular hypoperfusion of the optic nerve induced by high intrathecally produced ET-1, a potential prognostic marker of ON recovery in MS. The detection of CSF ET-1 levels may allow identifying groups of ON patients potentially benefitting from treatment with ET-1 antagonists (e.g., bosentan).
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25
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Filgueiras TG, Oyamada MK, Preti RC, Apóstolos-Pereira SL, Callegaro D, Monteiro MLR. Outer Retinal Dysfunction on Multifocal Electroretinography May Help Differentiating Multiple Sclerosis From Neuromyelitis Optica Spectrum Disorder. Front Neurol 2019; 10:928. [PMID: 31507527 PMCID: PMC6718638 DOI: 10.3389/fneur.2019.00928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose: To evaluate the intermediate and outer retina of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using OCT and multifocal electroretinography (mf-ERG). Methods: Patients with MS (n = 30), NMOSD (n = 30), and healthy controls (n = 29) underwent visual field (VF), OCT, and mf-ERG testing. The eyes were distributed into 5 groups: MS with or without history of ON (MS+ON, MS-ON), NMOSD with or without ON (NMOSD+ON, NMOSD-ON), and controls. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, and photoreceptor layer was measured. mf-ERG P1 and N1 responses were registered and grouped in 3 sets of rings. The groups were compared using GEE models, and effect size (ES) calculated. Results: Compared to controls, GCL and IPL thickness was significantly smaller in MS+ON (both p < 0.01), MS-ON (p < 0.01 and p = 0.015, respectively), NMOSD+ON (both p < 0.01) and NMOSD-ON (p = 0.03 and p = 0.018, respectively). ES was >0.80. mRNFL was smaller in three of the above groups (p < 0.01, p < 0.001, and p = 0.028; ES > 0.80) but not in MS-ON eyes (p = 0.18). No significant difference was observed for the remaining layers. Compared to controls, P1 and N1 peak times were shorter in MS (p-values in the range 0.049-0.002, ES < 0.50; and 0.049-0.010; ES < 0.50, respectively) but not in NMOSD. These abnormalities were strongly correlated with intermediate and outer retinal layer thickness. Conclusions: mf-ERG data suggest outer retinal abnormalities in MS, but not in NMOSD. Our results may help understand how the two conditions differ regarding retinal damage.
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Affiliation(s)
- Thiago G. Filgueiras
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria K. Oyamada
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Rony C. Preti
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Dagoberto Callegaro
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mário L. R. Monteiro
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
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26
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Shao Y, Jiang H, Wei Y, Shi Y, Shi C, Wright CB, Sun X, Vanner EA, Rodriguez AD, Lam BL, Rundek T, Baumel BS, Gameiro GR, Dong C, Wang J. Visualization of Focal Thinning of the Ganglion Cell-Inner Plexiform Layer in Patients with Mild Cognitive Impairment and Alzheimer's Disease. J Alzheimers Dis 2019; 64:1261-1273. [PMID: 30040712 DOI: 10.3233/jad-180070] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A detailed analysis of the tomographic thickness of intraretinal layers may provide more information on neurodegeneration in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). OBJECTIVE The goal was to analyze tomographic thickness patterns of intraretinal layers in patients with AD andMCI. METHOD Forty-nine patients (25 AD and 24 MCI) and 21 cognitively normal (CN) controls were imaged using ultra-high-resolution optical coherence tomography to obtain volumetric data centered on the fovea. The segmented intraretinal layers were retinal nerve fiber layer (RNFL), ganglion cell- inner plexiform layer (GCIPL), inner nuclear layer (INL), outer nuclear layer (ONL), outer plexiform layer (OPL), and retinal photoreceptor (PR), in addition to the total retinal thickness(TRT). RESULTS The thickness differences were negative (thinning) mainly in TRT, RNFL, and GCIPL in both AD and MCI groups in comparison to CN, while the thickness differences were positive (thickening) mainly in ONL and PR in AD. GCIPL of AD and MCI was thinner in superior, nasal superior, and temporal superior quadrants, compared to CN (p < 0.05). GCIPL of the inner superior, inner nasal superior, inner temporal superior, and outer nasal superior sectors was significantly thinner in AD than CN (p < 0.05). GCIPL of the outer superior, inner temporal superior, outer nasal, and temporal superior sectors was significantly thinner in MCI than CN (p < 0.05). CONCLUSION Focal thinning of the GCIPL was visualized and quantified by detailed partitions in AD and MCI, which provides specific information about neurodegeneration in MCI and AD.
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Affiliation(s)
- Yi Shao
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurology and the Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yantao Wei
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ce Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Xiaoyan Sun
- Department of Neurology and the Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,BioStatistics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anny D Rodriguez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,BioStatistics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Byron L Lam
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology and the Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Barry S Baumel
- Department of Neurology and the Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovana Rosa Gameiro
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chuanhui Dong
- Department of Neurology and the Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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27
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Dembla M, Kesharwani A, Natarajan S, Fecher-Trost C, Fairless R, Williams SK, Flockerzi V, Diem R, Schwarz K, Schmitz F. Early auto-immune targeting of photoreceptor ribbon synapses in mouse models of multiple sclerosis. EMBO Mol Med 2019; 10:emmm.201808926. [PMID: 30266776 PMCID: PMC6220320 DOI: 10.15252/emmm.201808926] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optic neuritis is one of the first manifestations of multiple sclerosis. Its pathogenesis is incompletely understood, but considered to be initiated by an auto‐immune response directed against myelin sheaths of the optic nerve. Here, we demonstrate in two frequently used and well‐validated mouse models of optic neuritis that ribbon synapses in the myelin‐free retina are targeted by an auto‐reactive immune system even before alterations in the optic nerve have developed. The auto‐immune response is directed against two adhesion proteins (CASPR1/CNTN1) that are present both in the paranodal region of myelinated nerves as well as at retinal ribbon synapses. This occurs in parallel with altered synaptic vesicle cycling in retinal ribbon synapses and altered visual behavior before the onset of optic nerve demyelination. These findings indicate that early synaptic dysfunctions in the retina contribute to the pathology of optic neuritis in multiple sclerosis.
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Affiliation(s)
- Mayur Dembla
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Medical School, Saarland University, Homburg, Germany
| | - Ajay Kesharwani
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Medical School, Saarland University, Homburg, Germany
| | - Sivaraman Natarajan
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Medical School, Saarland University, Homburg, Germany
| | - Claudia Fecher-Trost
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical School, Saarland University, Homburg, Germany
| | - Richard Fairless
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Sarah K Williams
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Veit Flockerzi
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical School, Saarland University, Homburg, Germany
| | - Ricarda Diem
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Karin Schwarz
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Medical School, Saarland University, Homburg, Germany
| | - Frank Schmitz
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Medical School, Saarland University, Homburg, Germany
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28
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Rothman A, Murphy OC, Fitzgerald KC, Button J, Gordon-Lipkin E, Ratchford JN, Newsome SD, Mowry EM, Sotirchos ES, Syc-Mazurek SB, Nguyen J, Caldito NG, Balcer LJ, Frohman EM, Frohman TC, Reich DS, Crainiceanu C, Saidha S, Calabresi PA. Retinal measurements predict 10-year disability in multiple sclerosis. Ann Clin Transl Neurol 2019; 6:222-232. [PMID: 30847355 PMCID: PMC6389740 DOI: 10.1002/acn3.674] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/30/2018] [Accepted: 09/27/2018] [Indexed: 12/30/2022] Open
Abstract
Objective Optical coherence tomography (OCT)‐derived measures of the retina correlate with disability and cortical gray matter atrophy in multiple sclerosis (MS); however, whether such measures predict long‐term disability is unknown. We evaluated whether a single OCT and visual function assessment predict the disability status 10 years later. Methods Between 2006 and 2008, 172 people with MS underwent Stratus time domain‐OCT imaging [160 with measurement of total macular volume (TMV)] and high and low‐contrast letter acuity (LCLA) testing (n = 150; 87%). All participants had Expanded Disability Status Scale (EDSS) assessments at baseline and at 10‐year follow‐up. We applied generalized linear regression models to assess associations between baseline TMV, peripapillary retinal nerve fiber layer (pRNFL) thickness, and LCLA with 10‐year EDSS scores (linear) and with clinically significant EDSS worsening (binary), adjusting for age, sex, optic neuritis history, and baseline disability status. Results In multivariable models, lower baseline TMV was associated with higher 10‐year EDSS scores (mean increase in EDSS of 0.75 per 1 mm3 loss in TMV (mean difference = 0.75; 95% CI: 0.11–1.39; P = 0.02). In analyses using tertiles, individuals in the lowest tertile of baseline TMV had an average 0.86 higher EDSS scores at 10 years (mean difference = 0.86; 95% CI: 0.23–1.48) and had over 3.5‐fold increased odds of clinically significant EDSS worsening relative to those in the highest tertile of baseline TMV (OR: 3.58; 95% CI: 1.30–9.82; Ptrend = 0.008). pRNFL and LCLA predicted the 10‐year EDSS scores only in univariate models. Interpretation Lower baseline TMV measured by OCT significantly predicts higher disability at 10 years, even after accounting for baseline disability status.
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Affiliation(s)
- Alissa Rothman
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Olwen C Murphy
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - Julia Button
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - John N Ratchford
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Scott D Newsome
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Ellen M Mowry
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | | | - James Nguyen
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | | | - Laura J Balcer
- Department of Neurology New York University Langone Medical Center New York New York
| | - Elliot M Frohman
- Department of Neurology and Ophthalmology Dell Medical School University of Texas Austin Austin Texas
| | - Teresa C Frohman
- Department of Neurology and Ophthalmology Dell Medical School University of Texas Austin Austin Texas
| | - Daniel S Reich
- Department of Neurology Johns Hopkins University Baltimore Maryland.,Translational Neuroradiology Unit National Institutes of Health Bethesda Maryland.,Department of Biostatistics Johns Hopkins University Baltimore Maryland
| | | | - Shiv Saidha
- Department of Neurology Johns Hopkins University Baltimore Maryland
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Jankowska-Lech I, Wasyluk J, Palasik W, Terelak-Borys B, Grabska-Liberek I. Peripapillary retinal nerve fiber layer thickness measured by optical coherence tomography in different clinical subtypes of multiple sclerosis. Mult Scler Relat Disord 2019; 27:260-268. [DOI: 10.1016/j.msard.2018.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/12/2018] [Accepted: 11/02/2018] [Indexed: 01/28/2023]
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Lamin A, Oakley JD, Dubis AM, Russakoff DB, Sivaprasad S. Changes in volume of various retinal layers over time in early and intermediate age-related macular degeneration. Eye (Lond) 2018; 33:428-434. [PMID: 30310161 DOI: 10.1038/s41433-018-0234-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate longitudinally volume changes in inner and outer retinal layers in early and intermediate age-related macular degeneration (AMD) compared to healthy control eyes using optical coherence tomography (OCT). METHODS 71 eyes with AMD and 31 control eyes were imaged at two time points: baseline and after 2 years. Automated OCT layer segmentation was performed using OrionTM. This software is able to measure volumes of retinal layers with distinct boundaries including Retinal Nerve Fibre Layer (RNFL), Ganglion Cell-Inner Plexiform Layer (GCIPL), Inner Nuclear Layer (INL), Outer Plexiform Layer (OPL), Outer Nuclear Layer (ONL), Photoreceptors (PR) and Retinal Pigment Epithelium-Bruch's Membrane complex (RPE-BM). The mean retinal layer volumes and volume changes at 2 years were compared between groups. RESULTS Mean GCIPL and INL volumes were lower, while PR and RPE-BM volumes were higher in AMD eyes than controls at baseline (all P < 0.05) and year 2 (all P < 0.05). In AMD eyes, RNFL and ONL volumes decreased by 0.0232 (P = 0.033) and 0.0851 (P = 0.001), respectively. In contrast, OPL and RPE-BM volumes increased in AMD eyes by 0.0391 (P = 0.000) and 0.0209 (P = 0.000) respectively. Moreover, there were significant differences in longitudinal volume change of OPL (P = 0.02), ONL (P = 0.008) and RPE-BM (P = 0.02) between AMD eyes and controls. CONCLUSIONS There were abnormal retinal layer volumes and volume changes in eyes with early and intermediate AMD.
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Affiliation(s)
- Ali Lamin
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Adam M Dubis
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK. .,UCL Institute of Ophthalmology, London, UK.
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Chakravarty A, Sivaswamy J. A supervised joint multi-layer segmentation framework for retinal optical coherence tomography images using conditional random field. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 165:235-250. [PMID: 30337078 DOI: 10.1016/j.cmpb.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/03/2018] [Accepted: 09/03/2018] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Accurate segmentation of the intra-retinal tissue layers in Optical Coherence Tomography (OCT) images plays an important role in the diagnosis and treatment of ocular diseases such as Age-Related Macular Degeneration (AMD) and Diabetic Macular Edema (DME). The existing energy minimization based methods employ multiple, manually handcrafted cost terms and often fail in the presence of pathologies. In this work, we eliminate the need to handcraft the energy by learning it from training images in an end-to-end manner. Our method can be easily adapted to pathologies by re-training it on an appropriate dataset. METHODS We propose a Conditional Random Field (CRF) framework for the joint multi-layer segmentation of OCT B-scans. The appearance of each retinal layer and boundary is modeled by two convolutional filter banks and the shape priors are modeled using Gaussian distributions. The total CRF energy is linearly parameterized to allow a joint, end-to-end training by employing the Structured Support Vector Machine formulation. RESULTS The proposed method outperformed three benchmark algorithms on four public datasets. The NORMAL-1 and NORMAL-2 datasets contain healthy OCT B-scans while the AMD-1 and DME-1 dataset contain B-scans of AMD and DME cases respectively. The proposed method achieved an average unsigned boundary localization error (U-BLE) of 1.52 pixels on NORMAL-1, 1.11 pixels on NORMAL-2 and 2.04 pixels on the combined NORMAL-1 and DME-1 dataset across the eight layer boundaries, outperforming the three benchmark methods in each case. The Dice coefficient was 0.87 on NORMAL-1, 0.89 on NORMAL-2 and 0.84 on the combined NORMAL-1 and DME-1 dataset across the seven retinal layers. On the combined NORMAL-1 and AMD-1 dataset, we achieved an average U-BLE of 1.86 pixels on the ILM, inner and outer RPE boundaries and a Dice of 0.98 for the ILM-RPEin region and 0.81 for the RPE layer. CONCLUSION We have proposed a supervised CRF based method to jointly segment multiple tissue layers in OCT images. It can aid the ophthalmologists in the quantitative analysis of structural changes in the retinal tissue layers for clinical practice and large-scale clinical studies.
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Affiliation(s)
- Arunava Chakravarty
- Centre for Visual Information Technology, International Institute of Information Technology, Hyderabad 500032, India.
| | - Jayanthi Sivaswamy
- Centre for Visual Information Technology, International Institute of Information Technology, Hyderabad 500032, India.
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Zivadinov R, Tavazzi E, Hagemeier J, Carl E, Hojnacki D, Kolb C, Weinstock-Guttman B. The Effect of Glatiramer Acetate on Retinal Nerve Fiber Layer Thickness in Patients with Relapsing-Remitting Multiple Sclerosis: A Longitudinal Optical Coherence Tomography Study. CNS Drugs 2018; 32:763-770. [PMID: 29767815 DOI: 10.1007/s40263-018-0521-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Optical coherence tomography (OCT) is a technique that allows for the assessment of retinal nerve fiber layer thickness (RNFLT) and total macular volume (TMV), which reflect neuroaxonal integrity within the retina. As such it has been used in multiple sclerosis (MS) to study neurodegeneration. Glatiramer acetate (GA) is a widely used treatment for MS, which is suggested to have a possible neuroprotective role. OBJECTIVE The aim of this study was to assess RFNLT and TMV changes in relapsing-remitting MS (RRMS) patients who started treatment with GA and were followed for a 24-month period. METHODS A cohort of 60 RRMS patients and 40 healthy controls (HCs) were imaged with OCT at baseline and follow-up. All subjects also underwent clinical and neurological examination. Measurements were compared between the RRMS patients and HCs as well as between optic neuritis (ON)-affected and ON-unaffected eyes. RESULTS At baseline, MS patients showed lower average RNFLT (p = 0.046) and TMV (p = 0.013) when compared with HCs. No significant differences in the evolution of OCT measures were detected over the follow-up between MS patients and HCs. MS patients with both affected and unaffected eyes showed significantly lower average RNFLT, temporal inferior RNFLT, and TMV at baseline, compared with HCs. No significant differences between ON-affected and ON-unaffected eyes in MS patients were detected over the follow-up, except for the nasal superior RNFLT (p = 0.019). CONCLUSIONS This study suggests a beneficial role of GA on retinal axonal degeneration in MS, and further confirms the utility of OCT to monitor the neuroprotective effect of disease-modifying treatment.
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Affiliation(s)
- Robert Zivadinov
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA. .,Center for Biomedical Imaging at Clinical and Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Eleonora Tavazzi
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Jesper Hagemeier
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - Ellen Carl
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA
| | - David Hojnacki
- Department of Neurology, School of Medicine and Biomedical Sciences, Jacobs Multiple Sclerosis Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Channa Kolb
- Department of Neurology, School of Medicine and Biomedical Sciences, Jacobs Multiple Sclerosis Center, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, School of Medicine and Biomedical Sciences, Jacobs Multiple Sclerosis Center, University at Buffalo, State University of New York, Buffalo, NY, USA
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Alonso R, Gonzalez-Moron D, Garcea O. Optical coherence tomography as a biomarker of neurodegeneration in multiple sclerosis: A review. Mult Scler Relat Disord 2018; 22:77-82. [PMID: 29605802 DOI: 10.1016/j.msard.2018.03.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/27/2022]
Abstract
Neurodegeneration is one the most important pathological factors which contributes to permanent disability in multiple sclerosis (MS). Optical coherence tomography (OCT) measurements of macular ganglion cell layer (mGCL) and retinal nerve fiber layer (RNFL) have been proposed as biomarkers of axonal damage in MS. The aim of this review is to describe the most relevant findings regarding OCT and axonal damage in MS. We have selected studies that describe retina impairment in MS patients, and those which quantitatively assess the relationship between OCT and physical disability, cognitive impairment and relationship between OCT and magnetic resonance imaging (MRI). Results show that there is a relationship between the degree of retinal layers reduction and physical or cognitive disability and degenerative changes in MRI.
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Affiliation(s)
- Ricardo Alonso
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina.
| | - Dolores Gonzalez-Moron
- Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina; Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Orlando Garcea
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina
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You Y, Graham EC, Shen T, Yiannikas C, Parratt J, Gupta V, Barton J, Dwyer M, Barnett MH, Fraser CL, Graham SL, Klistorner A. Progressive inner nuclear layer dysfunction in non-optic neuritis eyes in MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e427. [PMID: 29259999 PMCID: PMC5732006 DOI: 10.1212/nxi.0000000000000427] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/09/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate primary retinal functional changes in non-optic neuritis (ON) eyes of patients with MS by full-field electroretinography (ERG). METHODS Seventy-seven patients with relapsing-remitting MS with no history of clinical ON in at least 1 eye and 30 healthy controls were recruited in the cohort study. Full-field ERGs were recorded, and retinal optical coherence tomography scans were performed to assess the thicknesses of peripapillary retinal nerve fiber layer (RNFL) and retinal ganglion cell layer-inner plexiform layer (GCL-IPL). Annual MRI scans were also carried out to evaluate the disease activity in the brain. Patients were followed up for 3 years. RESULTS At baseline, a delayed b-wave peak time was observed in the cone response (p < 0.001), which was associated with the thicknesses of RNFL and GCL-IPL. The peak time of the delayed b-wave also correlated with the Expanded Disability Status Scale, T2 lesion volume, and disease duration. During the 3-year follow-up, progressive ERG amplitude reduction was observed (both a- and b-waves, p < 0.05). There was a correlation between the b-wave amplitude reduction and longitudinal RNFL loss (p = 0.001). However, no correlation was found between longitudinal ERG changes and disease activity in the brain. CONCLUSIONS This study demonstrated progressive inner nuclear layer dysfunction in MS. The borderline a-wave changes suggested some outer retinal dysfunction as well. The correlation between full-field ERG changes and retinal ganglion cell loss suggested that there might be subclinical retinal pathology in MS affecting both outer and inner retinal layers.
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Affiliation(s)
- Yuyi You
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Elizabeth C Graham
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Ting Shen
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Con Yiannikas
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - John Parratt
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Vivek Gupta
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Joshua Barton
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Michael Dwyer
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Michael H Barnett
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Clare L Fraser
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Stuart L Graham
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
| | - Alexander Klistorner
- Save Sight Institute (Y.Y., E.C.G., C.L.F., A.K.), The University of Sydney; Department of Health and Medical Sciences (Y.Y., T.S., V.G., S.L.G., A.K.), Macquarie University; Department of Neurology (C.Y., J.P.), Royal North Shore Hospital; Brain and Mind Center (J.B., M.H.B.), The University of Sydney; Sydney Neuroimaging Analysis Center (M.H.B., A.K.), New South Wales, Australia; and Buffalo Neuroimaging Analysis Center (M.D.), University at Buffalo, NY
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de Araújo RB, Oyamada MK, Zacharias LC, Cunha LP, Preti RC, Monteiro MLR. Morphological and Functional Inner and Outer Retinal Layer Abnormalities in Eyes with Permanent Temporal Hemianopia from Chiasmal Compression. Front Neurol 2017; 8:619. [PMID: 29255441 PMCID: PMC5723053 DOI: 10.3389/fneur.2017.00619] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/06/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The aims of this study are to compare optical coherence tomography (OCT)-measured macular retinal layers in eyes with permanent temporal hemianopia from chiasmal compression and control eyes; to compare regular and slow-flash multifocal electroretinography (mfERG) in patients and controls; and to assess the correlation between OCT, mfERG, and central visual field (SAP) data. Methods Forty-three eyes of 30 patients with permanent temporal hemianopia due to pituitary tumors who were previously submitted to chiasm decompression and 37 healthy eyes of 19 controls were submitted to macular spectral domain OCT, mfERG, and 10-2 SAP testing. After segmentation, the thickness of the macular retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer, and photoreceptor layer (PRL) was measured. Amplitudes and oscillatory potentials (OPs) were measured on regular and slow-flash mfERG, respectively, and expressed as the mean values per quadrant and hemifield. Results RNFL, GCL, and IPL thickness measurements were significantly reduced in all quadrants, whereas INL, OPL, and PRL thicknesses were significantly increased in the nasal quadrants in patients compared to those in controls. Significant correlations between OCT and 10-2 SAP measurements were positive for the RNFL, GCL, and IPL and negative for the INL, OPL, and PRL. OPs and mfERG N1 amplitudes were significantly reduced in the nasal hemiretina of patients. Significant correlations were found between OP and mfERG amplitudes for inner and outer nasal hemiretina OCT measurements, respectively. Conclusion Patients with permanent temporal hemianopia from previously treated chiasmal compression demonstrated significant thinning of the RNFL, GCL, IPL, and thickening of the INL, OPL, and PRL associated with reduced OP and mfERG N1 amplitudes, suggesting that axonal injury to the inner retina leads to secondary damage to the outer retina in this condition.
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Affiliation(s)
- Rafael B de Araújo
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria K Oyamada
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C Zacharias
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo P Cunha
- Department of Ophtalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rony C Preti
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mário L R Monteiro
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
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Pietroboni AM, Dell'Arti L, Caprioli M, Scarioni M, Carandini T, Arighi A, Ghezzi L, Fumagalli GG, De Riz MA, Basilico P, Colombi A, Benatti E, Triulzi F, Scarpini E, Viola F, Galimberti D. The loss of macular ganglion cells begins from the early stages of disease and correlates with brain atrophy in multiple sclerosis patients. Mult Scler 2017; 25:31-38. [PMID: 29125019 DOI: 10.1177/1352458517740214] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The importance of neurodegeneration in multiple sclerosis (MS) is increasingly well recognized. OBJECTIVES To evaluate retinal pathology using optical coherence tomography (OCT) and to investigate possible associations between retinal layers' thickness and specific patterns of gray matter volume in patients with a new diagnosis of MS. METHODS A total of 31 patients underwent OCT scans and brain magnetic resonance imaging. In total, 30 controls underwent the same OCT procedure. The association between focal cortical volume and OCT measurements was investigated with voxel-based morphometry (VBM). RESULTS Compared to controls, patients' macular retinal nerve fiber layer (mRNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL), and macular ganglion cell-inner plexiform layer (mGCIPL) thickness were significantly reduced ( p = 0.0009, p = 0.0003, p = 0.0049, and p = 0.0007, respectively). Peripapillary RNFL (pRNFL) and temporal sector pRNFL (T-pRNFL) did not show any significant changes, although there was a trend toward T-pRNFL thinning ( p = 0.0254). VBM analysis showed that mGCIPL and pRNFL were significantly correlated with the volume reduction of occipital-parietal cortex ( p < 0.005). CONCLUSION mRNFL, mGCL, and mIPL are significantly reduced in MS patients without concomitant pRNFL thinning. These retinal changes show a significant association with cortical regions that are known to be important for visuospatial performance.
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Affiliation(s)
- Anna M Pietroboni
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Dell'Arti
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Caprioli
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Scarioni
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Carandini
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Arighi
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Ghezzi
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio G Fumagalli
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Milena A De Riz
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Basilico
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Colombi
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Benatti
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Elio Scarpini
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Ophthalmological Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Galimberti
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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Rashno A, Nazari B, Koozekanani DD, Drayna PM, Sadri S, Rabbani H, Parhi KK. Fully-automated segmentation of fluid regions in exudative age-related macular degeneration subjects: Kernel graph cut in neutrosophic domain. PLoS One 2017; 12:e0186949. [PMID: 29059257 PMCID: PMC5653365 DOI: 10.1371/journal.pone.0186949] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/10/2017] [Indexed: 11/19/2022] Open
Abstract
A fully-automated method based on graph shortest path, graph cut and neutrosophic (NS) sets is presented for fluid segmentation in OCT volumes for exudative age related macular degeneration (EAMD) subjects. The proposed method includes three main steps: 1) The inner limiting membrane (ILM) and the retinal pigment epithelium (RPE) layers are segmented using proposed methods based on graph shortest path in NS domain. A flattened RPE boundary is calculated such that all three types of fluid regions, intra-retinal, sub-retinal and sub-RPE, are located above it. 2) Seed points for fluid (object) and tissue (background) are initialized for graph cut by the proposed automated method. 3) A new cost function is proposed in kernel space, and is minimized with max-flow/min-cut algorithms, leading to a binary segmentation. Important properties of the proposed steps are proven and quantitative performance of each step is analyzed separately. The proposed method is evaluated using a publicly available dataset referred as Optima and a local dataset from the UMN clinic. For fluid segmentation in 2D individual slices, the proposed method outperforms the previously proposed methods by 18%, 21% with respect to the dice coefficient and sensitivity, respectively, on the Optima dataset, and by 16%, 11% and 12% with respect to the dice coefficient, sensitivity and precision, respectively, on the local UMN dataset. Finally, for 3D fluid volume segmentation, the proposed method achieves true positive rate (TPR) and false positive rate (FPR) of 90% and 0.74%, respectively, with a correlation of 95% between automated and expert manual segmentations using linear regression analysis.
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Affiliation(s)
- Abdolreza Rashno
- Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN, United States of America
| | - Behzad Nazari
- Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Dara D. Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Paul M. Drayna
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Saeed Sadri
- Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Hossein Rabbani
- Department of Biomedical Engineering, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keshab K. Parhi
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN, United States of America
- * E-mail:
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