Retinal periphlebitis is associated with multiple sclerosis severity

Abstract

Objectives: To assess the association of primary retinal inflammation, namely retinal periphlebitis (RP) and microcystic macular edema, with clinical, brain, and retinal imaging biomarkers of multiple sclerosis (MS) severity.Methods: One hundred patients with MS underwent a neurologic and ophthalmic examination, MRI, and optical coherence tomography. Disability was assessed using the Expanded Disability Status Scale at baseline and after a 1-year follow-up. The normalized brain volume, the normalappearing gray matter volume, and T1 lesion volume were assessed at baseline as radiologic biomarkers of disease severity. Retinal nerve fiber layer thickness and macular volume at baseline were used as surrogate markers of axonal damage. We used general linear models adjusted for sex, age, disease duration, and MS treatment to compared adjusted means of these parameters among patients with RP and patients without primary retinal inflammation.Results: Five patients showed RP, 2 showed microcystic macular edema, and the retina was normal in the remaining 93. Patients with RP had a tendency toward a higher adjusted-mean Expanded Disability Status Scale score at baseline and disability progression after a 1-year follow-up compared with patients without primary retinal inflammation. These patients also had a higher adjusted-mean T1 lesion volume (adjusted differences: 10.4, 95% confidence interval [CI]: 0.6 to 20.2; p 5 0.038) and lower T1 brain volume (adjusted differences: 268, 95% CI: 2139 to 2; p 5 0.059). Patients with RP had a lower adjusted-mean retinal nerve fiber layer thickness (adjusted differences: 213.4, 95% CI: 224.4 to 22.3; p 5 0.018) and a trend toward lower macular volume. Multiple sclerosis (MS) causes axonal degeneration, determining disease severity. Retinal periphlebitis (RP) is a vasculitis that affects the peripheral retina in approximately 10% of patients with MS. The presence of RP is associated with a higher disease activity in relapses and gadoliniumenhancing lesions. Conclusions:1 Additionally, optical coherence tomography (OCT) has identified retinal nerve fiber layer (RNFL) atrophy and a decreased macular volume (MV) as axonal damage markers in MS. 224 Moreover, OCT enabled identification of microcystic macular edema (MME) in 0.5% to 5% of patients with MS and it seems to be associated with MS activity or previous optic neuritis (ON).2 In this study, we assessed the association between primary retinal inflammation (RP and MME) and clinical (Expanded Disability Status Scale [EDSS]) and imaging (brain and retinal) biomarkers of disease severity to evaluate their suitability as biomarkers in MS.

Retinal microvascular network alterations: potential biomarkers of cerebrovascular and neural diseases

“…These vascular alterations could play a role in neurodegeneration; however, measurements or even just the characterization of cerebral blood flow is a challenging task. On the other hand, retinal periphlebitis and stiffness of central retinal arteries have been reported in MS (64,94). Our group recently reported significant differences in the nerve fiber layer and the ganglion cell/plexiform layer compound in MS patients compared with healthy subjects along with changes in the retinas affected by optic neuritis compared with those unaffected (128).…”

Vision and vision-related outcome measures in multiple sclerosis

“…Approximately 10% of patients with multiple sclerosis have retinal periphlebitis, the presence of which is associated with increased disease activity ( Sepulcre et al , 2007 ; Ortiz-Perez et al , 2013 ). Multiple sclerosis is associated with uveitis or pars planitis in up to 15–20% of cases ( Lightman et al , 1987 ; Biousse et al , 1999 ; Donaldson et al , 2007 ).…”

Impaired retinal microcirculation in multiple sclerosis

“…10 The vasculature in the eye and brain are anatomically and physiologically similar. 11 Aside from the common occurrence of retinal periphlebitis, 12 and increased retinal vessel rigidity suggesting vascular dysregulation, 13 there is a lack of information to support the hypothesis that retinal microcirculation alteration exists in MS. The goal of the present study was to characterize the retinal microcirculation in patients with MS by directly measuring the blood flow velocity and flow volume in retinal arterioles and venules.…”