Optical coherence tomography evaluation of retinal nerve fiber layer in longitudinally extensive transverse myelitis

Optical Coherence Tomography and Subclinical Optical Neuritis in Longitudinally Extensive Transverse Myelitis

Objective

The aim is to compare the retinal nerve fiber layer (RNFL) thickness of longitudinally extensive transverse myelitis (LETM) eyes without previous optic neuritis with that of healthy control subjects.

Methods

Over 20 LETM eyes and 20 normal control eyes were included in the study and subjected to optical coherence tomography to evaluate and compare the RNFL thickness.

Result

Significant RNFL thinning was observed at 8 o'clock position in LETM eyes as compared to the control eyes (P = 0.038). No significant differences were seen in other RNFL measurements.

Conclusion

Even in the absence of previous optic neuritis LETM can lead to subclinical axonal damage leading to focal RNFL thinning.

Evaluation of the retinal nerve fiber layer in neuromyelitis optica spectrum disorders: A systematic review and meta-analysis

BACKGROUND

An increasing number of studies have investigated the value of optical coherence tomography in patients with neuromyelitis optica (NMO) spectrum disorders; however, no systematic review has been performed to date. We aimed to systematically review and investigate the possibility of differentiating NMO and multiple sclerosis (MS) via an optical coherence tomography measurement.

METHODS

Electronic databases, including MEDLINE, EMBASE and Web of Science, were systematically searched up to June 2017. A meta-analysis was performed to compare the retinal nerve fiber layer (RNFL) thickness between patients with NMO and MS (or healthy controls).

RESULTS

Twenty-four studies were identified. The meta-analysis demonstrated that the RNFL loss was substantially more severe in NMO than in MS; however, subclinical axon damage was also found in eyes without optic neuritis in NMO. The intereye RNFL difference between eyes with or without optic neuritis was more prominent in NMO (-30.98μm) than in MS (-9.87μm).

CONCLUSION

The RNFL loss was more severe in NMO than in MS, and the intereye RNFL difference between eyes with or without optic neuritis may be useful in differentiating NMO from MS.

Glaucoma masqueraders: Diagnosis by spectral domain optical coherence tomography

BACKGROUND

Advances in optic nerve and retinal imaging have dramatically changed the care of glaucoma patients, complementing the importance of the clinical exam of the optic nerve and automated perimetry in making the diagnosis of glaucoma. Computerized imaging, however, does not replace the clinical exam, as there can be overlap in the appearance of non-glaucomatous optic neuropathies with glaucoma.

METHODS

The spectral domain optic coherence tomography (SD-OCT) images of five patients with non-glaucomatous optic nerve pathology are presented.

CASES

The first patient had bilateral temporal thinning on OCT imaging and subsequent positive syphilis testing. The second patient had a glaucomatous-appearing inferior arcuate scotoma and associated superior thinning on OCT; these findings were due to buried optic nerve head drusen, clearly appreciated on OCT of the optic nerve head. Bilateral diffuse macular thinning, with preservation of the superior and inferior fiber bundles, was seen in the third patient, who had multiple sclerosis, with no clinical history of optic neuritis. Dense and marked thinning of a macular half, respecting the horizontal meridian, is seen in two patients, one patient with non-arteritic anterior ischemic optic neuropathy and lastly, in a patient with hemi-retinal vein occlusion.

CONCLUSION

SD-OCT of the optic nerve and retina complements the essential clinical examination of patients with glaucomatous and non-glaucomatous optic neuropathies.