[The three-year follow-up study of retinal changes in patients with multiple sclerosis]

Analysis of optical coherence tomography of the optic nerve head and of the retinal macular area in multiple sclerosis patients

BACKGROUND: Multiple sclerosis is a chronic autoimmune demyelinating disease of the central nervous system. Early diagnosis of the disease is extremely important for the just-in-time start of specific therapy. Optical coherence tomography (OCT) of the optic nerve head and retina can become an early marker of the neurodegenerative process in multiple sclerosis. AIM: To determine OCT-changes in the retinal nerve fiber layer (RNFL) thickness and retinal thickness in the macular area being most specific for multiple sclerosis. MATERIALS AND METHODS: 197 patients were examined, the study group consisted of 136 patients (274 eyes) with an established diagnosis of multiple sclerosis and the disease duration of at least 6 months. The control group included 61 healthy people (122 eyes). All patients underwent a standard ophthalmological examination, OCT was performed on Spectralis OCT (Heidelberg Engineering, Germany) using 2 scanning protocols: ONH-RC-Scan (Optic Nerve Head-Radial Circle Scan) and PPAA (Posterior Pole Asymmetry Analysis) RESULTS: Only 11 patients (8.1%) had a history of retrobulbar neuritis, the best corrected visual acuity was 0.7 and higher in 83 (81%) patients with multiple sclerosis, while the optic nerve head and retinal nerve fiber layer OCT-changes typical for multiple sclerosis were found in 118 patients (87%). The most prominent thinning of the retinal nerve fiber layer in group with multiple sclerosis was revealed in the temporal part of the optic nerve head (59.9 14.8 in the study group versus 76.6 12.0 in the control group; p 0.001), the least thinning was in the nasal half (66.6 14.3 in the study group versus 69.3 12.4 in the control group; p = 0.013). The retina in the macular area in multiple sclerosis patients was thinned over the entire area, the most significant changes were in the Outer Nasal 7 zone (303.3 20.4 in the study group versus 324.3 10.0 in the control group; p 0.001). Cluster analysis found 6 new retinal zones for mapping the macular area using the scanning protocol PPAA. In order to determine the prognostic value of the obtained zones, a logistic regression model was constructed, which with a sensitivity of 87.1% and a specificity of 81.6% allows concluding on the probability of having multiple sclerosis. CONCLUSION: OCT data using the proposed mapping of the macular area with the mathematical model analysis could be used to diagnose specific optic nerve atrophy, to reveal typical thinning of the retinal nerve fiber layer associated with multiple sclerosis, and in the long run, to become an additional criterion for establishing the diagnosis of multiple sclerosis.

Chronic demyelination exacerbates neuroaxonal loss in patients with MS with unilateral optic neuritis

Objective

To examine the effect of chronic demyelination in the optic nerve of patients with MS on progressive loss of retinal ganglion cell (RGC) axons.

Methods

Progressive retinal nerve fiber layer (RNFL) loss, as measured by optical coherence tomography, was longitudinally examined in 51 patients with MS with a history of unilateral optic neuritis (ON) and 25 normal controls. Patients were examined annually with a median of 4-year follow-up. Pairwise intereye comparison was performed between ON and fellow non-ON (NON) eyes of patients with MS using the linear mixed-effects model and survival analysis. The latency asymmetry of multifocal visual evoked potential (mfVEP) was used to determine the level of demyelination in the optic nerve.

Results

Although both ON and NON eyes demonstrate significantly faster loss of RGC axons compared with normal subjects, ON eyes with severe chronic demyelination show accelerated thinning in the RNFL in the temporal sector of the optic disc (temporal RNFL [tRNFL]) compared with fellow eyes (evidenced by both the linear mixed-effects model and survival analysis). Furthermore, progressive tRNFL thinning is associated with the degree of optic nerve demyelination and reflects the topography of pathology in the optic nerve. More rapid axonal loss in ON eyes is also functionally evidenced by mfVEP amplitude reduction, which correlates with the level of optic nerve demyelination.

Conclusions

Although the effect of demyelination on axonal survival has been demonstrated in experimental studies, our results provide first clinically meaningful evidence that chronic demyelination is associated with progressive axonal loss in human MS.

[An impact of glatiramer acetate (timexon) on the signs of neurodegeneration process in the neuronal layer of the retina in patients with relapsing-remitting multiple sclerosis]

AIM

To perform a comparative study of the results of optical coherence tomography of the retina in patients with relapsing-remitting multiple sclerosis, treated with glatiramer acetate (timexon).

MATERIAL AND METHODS

The study included 19 patients (16 women and 3 men) with relapsing-remitting multiple sclerosis who were treated with the glatiramer acetate generic drug timexon (BIOCAD, Russia). Dynamic changes in the main parameters of the optical coherence tomography linked with neurodegeneration manifestations in the retina during the year of the study were evaluated.

RESULTS AND CONCLUSION

The efficacy of timexon in the progression of neurodegenerative changes in the retina was shown.