Dynamics of Retinal Vessel Loss After Acute Optic Neuritis in Patients With Relapsing Multiple Sclerosis

Aly, Lilian; Noll, Christina; Wicklein, Rebecca; Wolf, Elisabeth; Romahn, Eva Feodora; Wauschkuhn, Josphine; Hosari, Sami; Mardin, Christian Y.; Berthele, Achim; Hemmer, Bernhard; Korn, Thomas; Knier, Benjamin

doi:10.1212/nxi.0000000000001159

Cited by 19 publications

(36 citation statements)

References 31 publications

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“…and was manually corrected if necessary. OCT-A examinations were acquired on both eyes of each patient under low-lighting conditions using a spectral-domain OCT with angiography module (Heidelberg Engineering Spectralis OCT2) by two experienced technicians as previously described (6). En face images and decorrelation signals were recorded within a 2.9 × 2.9 mm area focusing on the fovea centralis with active eye tracking algorithm.…”

Section: Oct and Oct-a Analysismentioning

confidence: 99%

“…There is growing evidence that patients suffering from autoimmune diseases of the central nervous system also reveal alterations of the retinal vasculature. We could recently show that an acute optic neuritis (ON) leads to loss of retinal vessels within the superficial vascular complex (SVC) during the first 90 days after ON (6). Superficial vessel loss might also occur in eyes without a history of ON and might be linked to a worse visual function and disability (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis

et al. 2022

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BackgroundOptical coherence tomography angiography (OCT-A) is a novel technique allowing non-invasive assessment of the retinal vasculature. During relapsing remitting multiple sclerosis (RRMS), retinal vessel loss occurs in eyes suffering from acute optic neuritis and recent data suggest that retinal vessel loss might also be evident in non-affected eyes. We investigated whether alterations of the retinal vasculature are linked to the intrathecal immunity and whether they allow prognostication of the future disease course.Material and methodsThis study includes two different patient cohorts recruited at a tertiary German academic multiple sclerosis center between 2018 and 2020 and a cohort of 40 healthy controls. A total of 90 patients with RRMS undergoing lumbar puncture and OCT-A analysis were enrolled into a cross-sectional cohort study to search for associations between the retinal vasculature and the intrathecal immune compartment. We recruited another 86 RRMS patients into a prospective observational cohort study who underwent clinical examination, OCT-A and cerebral magnetic resonance imaging at baseline and during annual follow-up visits to clarify whether alterations of the retinal vessels are linked to RRMS disease activity. Eyes with a history of optic neuritis were excluded from the analysis.ResultsRarefication of the superficial vascular complex occured during RRMS and was linked to higher frequencies of activated B cells and higher levels of the pro-inflammatory cytokines interferon-γ, tumor necrosis factor α and interleukin-17 in the cerebrospinal fluid. During a median follow-up of 23 (interquartile range 14 - 25) months, vessel loss within the superficial (hazard ratio [HR] 1.6 for a 1%-point decrease in vessel density, p=0.01) and deep vascular complex (HR 1.6 for a 1%-point decrease, p=0.05) was associated with future disability worsening.DiscussionOptic neuritis independent rarefication of the retinal vasculature might be linked to neuroinflammatory processes during RRMS and might predict a worse disease course. Thus, OCT-A might be a novel biomarker to monitor disease activity and predict future disability.

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Section: Oct and Oct-a Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis

et al. 2022

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“…Few studies focused on the changes in the FAZ area in MS ( 15 – 17 ) showing ambiguous results, probably due to differences in OCTA devices ( 32 – 34 ). Only one study, conducted by Hayati et al, reported a significant correlation only between the FAZ area and the inner rings of SCP, analyzing a 3 × 3mm macula area ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies, using OCTA, found a significant impairment of retinal blood flow focusing on limited retinal fields, namely the macular region or the foveal avascular zone (FAZ) (13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Correlation analysis between foveal avascular zone and near peripheral retinal hypoperfusion in multiple sclerosis: a wide field optical coherence tomography angiography study

Montorio

Cennamo²,

Carotenuto³

et al. 2022

Front. Med.

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The identification of non-invasive biomarkers to investigate and monitor retinal structural and vascular changes in multiple sclerosis (MS) represents an interesting source of debate. Until now optical coherence tomography angiography (OCTA) evaluated the foveal avascular zone (FAZ) and areas of retinal non-perfusion only in the macular region in MS patients. It could be interesting to identify possible biomarkers, useful in assessing the ischemic areas also in the near peripheral retina, since FAZ enlargement and the areas of peripheral retinal non-perfusions share common pathogenic processes. In this cross-sectional study, we investigated the correlation between the FAZ area and retinal vessel density (VD) in the near peripheral retina by new wide-field optical coherence tomography angiography (OCTA) in patients affected by relapsing-remitting multiple sclerosis (RR-MS). Moreover, we compared the FAZ area and the VD of superficial and deep capillary plexuses in the fovea region and in the near peripheral retina (6.4 × 6.4 mm) between RR-MS patients and healthy controls by means of a Solix full-range OCTA. Last, we also detected the changes in structural OCT parameters (ganglion cell complex and retinal nerve fiber layer). Thirty-three eyes of 33 RR-MS patients and 35 eyes of 35 healthy controls were enrolled. RR-MS patients showed a lower VD in the superficial capillary plexus and a significant increase in the FAZ area compared with controls. The deep capillary plexus revealed a reduced VD although not statistically significant in patients with respect to controls. In the patients' group, the FAZ area showed significantly negative correlations with VD of superficial capillary plexuses in the foveal and whole region, while the FAZ area did not negatively correlate with the VD of the deep capillary plexus. The significant correlations among OCTA parameters could demonstrate the FAZ area as a possible biomarker for assessing the perfusion status in the near peripheral retina, useful in RR-MS management. These findings could confirm the role of vascular dysfunction in the pathogenetic mechanisms of MS.

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“…One recent study failed to find any significant differences in SVP VD between pwMS and controls but showed discrepancies between the two groups in the RNFL, GC-IPL, and radial peripapillary capillary (pRPC) VD [ 51 ]. Thinning of the SVP and enlargement of the FAZ appear to progress rapidly after an episode of ON and are associated with a persistent visual disability [ 52 ].…”

Section: Optical Coherence Tomography With Angiography In Multiple Sc...mentioning

confidence: 99%

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

et al. 2022

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

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Dynamics of Retinal Vessel Loss After Acute Optic Neuritis in Patients With Relapsing Multiple Sclerosis

Cited by 19 publications

References 31 publications

Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis

Association of the retinal vasculature, intrathecal immunity, and disability in multiple sclerosis

Correlation analysis between foveal avascular zone and near peripheral retinal hypoperfusion in multiple sclerosis: a wide field optical coherence tomography angiography study

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

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