High-Resolution Spectral Domain-Optical Coherence Tomography in Multiple Sclerosis, Part II - the Total Macular Volume. The First Follow-Up Study over 2 Years

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

AIM

To evaluate the ganglion cell complex (GCC) changes in projection to the state of the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS).

MATERIAL AND METHODS

A total of 216 participants (370 eyes) were studied. Patients were divided into three groups: 1-st - 87 MS patients (121 eyes) with a history of optic neuritis (ON); 2-nd - 95 MS patients (186 eyes) without a history of ON; 3-rd - disease-free control 34 volunteers (63 eyes). Thirty-two MS patients (61 eyes) from the cross-sectional cohort were included for longitudinal analysis, follow-up period was 30 (9.5-36) months. Sixteen patients (21 eyes) had a history of optic neuritis. The study included anamnesis, refracted visual acuity and optical coherence tomography (OCT) performed with the use of RTVue-100 ОСТ system.

RESULTS AND CONCLUSION

RNFL and GCC thickness was significantly decreased both in MS+ON and MS-ON groups compared to controls. No difference in the annual change of RNFL thickness and GCC parameters between patients with ON and patients who did not have any visual impairment in the anamnesis was found. Changes of GCC were detected only in patients with secondary progressive MS. The study of GCC and RNFL thickness can be used to describe and characterize the level of axonal damage in MS.

Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis

Introduction

Optical coherence tomography (OCT) with retinal segmentation analysis is a valuable tool in assessing axonal loss and neuro-degeneration in multiple sclerosis (MS) by in-vivo imaging, delineation and quantification of retinal layers. There is evidence of deep retinal involvement in MS beyond the inner retinal layers. The ultra-structural retinal changes in MS in different MS phenotypes can reflect differences in the pathophysiologic mechanisms. There is limited data on the pattern of deeper retinal layer involvement in progressive MS (PMS) versus relapsing remitting MS (RRMS). We have compared the OCT segmentation analysis in patients with relapsing-remitting MS and progressive MS.

Methods

Cross-sectional study of 113 MS patients (226 eyes) (29 PMS, 84 RRMS) and 38 healthy controls (72 eyes). Spectral domain OCT (SDOCT) using the macular cube acquisition protocol (Cirrus HDOCT 5000; Carl Zeiss Meditec) and segmentation of the retinal layers for quantifying the thicknesses of the retinal layers. Segmentation of the retinal layers was carried out utilizing Orion software (Voxeleron, USA) for quantifying the thicknesses of individual retinal layers.

Results

The retinal nerve finer layer (RNFL) (p = 0.023), the ganglion-cell/inner plexiform layer (GCIPL) (p = 0.006) and the outer plexiform layer (OPL) (p = 0.033) were significantly thinner in PMS compared to RRMS. There was significant negative correlation between the outer nuclear layer (ONL) and EDSS (r = -0.554, p = 0.02) in PMS patients. In RRMS patients with prior optic neuritis, the GCIPL correlated negatively (r = -0.317; p = 0.046), while the photoreceptor layer (PR) correlated positively with EDSS (r = 0.478; p = 0.003).

Conclusions

Patients with PMS exhibit more atrophy of both the inner and outer retinal layers than RRMS. The ONL in PMS and the GCIPL and PR in RRMS can serve as potential surrogate of disease burden and progression (EDSS). The specific retinal layer predilection and its correlation with disability may reflect different pathophysiologic mechanisms and various stages of progression in MS.

Assessment of Retinal and Choroidal Measurements in Chinese School-Age Children with Cirrus-HD Optical Coherence Tomography

Purpose

To evaluate retinal thickness (RT), retinal volume (RV) and choroidal thickness (ChT) in Chinese children using Cirrus-HD optical coherence tomography (OCT), and assess their associations with spherical equivalent (SE), age and gender.

Methods

This was a prospective study that recruited 193 healthy Chinese children (193 eyes) with no ophthalmic disease history between December 2012 and December 2013. RT and RV were acquired using OCT. Subfoveal ChT (SFCT) and ChT1-mm and 2-mm temporal, nasal, superior and inferior to the fovea were measured manually.

Results

RT in the inner temporal and nasal regionsdiffered significantly between refraction groups (both P<0.05). Significant differences were also found inSFCT andChT 1- and 2-mm inferior to the fovea (all P<0.05). RT differed significantly between males and females in the outer superior region in the emmetropia group (P<0.05). ChT differed significantly between males and females 2-mm temporal to the fovea in the emmetropia group (P<0.05), and 1-mm temporal to the fovea in the mild myopia group (P<0.05). SE correlated positively with RT in the inner temporal (r = 0.230),nasal (r = 0.252) and inferior (r = 0.149) regions (all P<0.05). Age correlated positively with foveolar (r = 0.169), total macular (r = 0.202), inner temporal (r = 0.237), inner nasal (r = 0.248), inner superior (r = 0.378) and inner inferior (r = 0.345) region thicknesses, and with RV (r = 0.207)(all P<0.05). SE correlated positively with SFCT (r = 0.195), and with ChT1-mm temporal (r = 0.167), 1- and 2-mm nasal (r = 0.144 and r = 0.162), 2-mm superior (r = 0.175), and 1- and 2-mm inferior (r = 0.207 and r = 0.238) to the fovea (all P<0.05). Age had no significant association with ChT.

Conclusions

SE, age and gender did not influence macular RT and ChT in most regions, and correlations of RT with age and ChT with SE were weak.

Repeatability Using Automatic Tracing with Canon OCT- HS100 and Zeiss Cirrus HD-OCT 5000

Background

Optical coherence tomography (OCT), can be used in clinical practice to provide high resolution cross-sectional images of the retina, optic disc and macula structure. These measurements can be useful for early detection, diagnosis, monitoring and treatment guidance for retinal diseases. Therefore, repeatability of measurements in OCT is of great importance.

Methods

Macula and optic disc parameters from the right eye of 30 healthy subjects were obtained twice with the Canon OCT-HS100 and Zeiss Cirrus HD-OCT 5000. Repeatability was evaluated by use of the coefficient of repeatability (CR) and the coefficient of repeatability as a percentage of the mean (CR%), and the obtained measurements were compared between the instruments.

Results

CR% of optic disc parameters ranged between 0.90 and 22.22% and 0.00 and 16.00% with the Canon and Zeiss OCT respectively. For macular parameters CR% ranged between 0.62 and 2.81% and 0.99 and 1.81% with the Canon and Zeiss OCT respectively. No statistical difference could be found when comparing the CR of all macular and disc measurements between the instruments. Compared to our previously published data repeatability has significantly improved with the inclusion of automatic tracking systems with both the Canon and Zeiss OCT.

Conclusion

Automatic tracking function improves repeatability in both Canon OCT-HS100 and Zeiss Cirrus HD-OCT 5000. However, measurements generated by the two instruments are still not interchangeable.

CROP - The Clinico-Radiologico-Ophthalmological Paradox in Multiple Sclerosis: Are Patterns of Retinal and MRI Changes Heterogeneous and Thus Not Predictable?

BACKGROUND

To date, no direct scientific evidence has been found linking tissue changes in multiple sclerosis (MS) patients, such as demyelination, axonal destruction or gliosis, with either steady progression and/or stepwise accumulation of focal CNS lesions. Tissue changes such as reduction of the retinal nerve fiber layer (RNFL) and the total macular volume (TMV), or brain- and spinal cord atrophy indicates an irreversible stage of tissue destruction. Whether these changes are found in all MS patients, and if there is a correlation with clinical disease state, remains controversial. The objective of our study was to determine, whether there was any correlation between the RNFL or TMV of patients with MS, and: (1) the lesion load along the visual pathways, (2) the ratios and absolute concentrations of metabolites in the normal-appearing white matter (NAWM), (3) standard brain atrophy indices, (4) disease activity or (5) disease duration.

METHODS

28 MS patients (RRMS, n = 23; secondary progressive MS (SPMS), n = 5) with moderately-high disease activity or long disease course were included in the study. We utilised: (1) magnetic resonance imaging (MRI) and (2) -spectroscopy (MRS), both operating at 3 Tesla, and (3) high-resolution spectral domain-OCT with locked reference images and eye tracking mode) to undertake the study.

RESULTS

There was no consistency in the pattern of CNS metabolites, brain atrophy indices and the RNFL/TMV between individuals, which ranged from normal to markedly-reduced levels. Furthermore, there was no strict correlation between CNS metabolites, lesions along the visual pathways, atrophy indices, RNFL, TMV, disease duration or disability.

CONCLUSIONS

Based on the findings of this study, we recommend that the concept of 'clinico-radiologico paradox' in multiple sclerosis be extended to CROP-'clinico-radiologico-ophthalmological paradox'. Furthermore, OCT data of MS patients should be interpreted with caution.