Emine KILIÇPARLAR CENGİZ, Aylin AKÇALI, Yasemin EKMEKYAPAR FIRAT, Cem ÖZTÜRKMEN, Gülsüm ÇOMRUK

Multipl skleroz hastalarında ganglion hücre kompleks kalınlığı ile maküler kalınlık arasında ilişki var mı?

Amaç: Optik Nörit (ON), Multipl Skleroz’un (MS) en sık saptanan göz bulgusudur. ON, aksonal kayba yol açıp hem Optik Koherens Tomografi (OCT) ve hem de görsel uyarılmış potansiyallerde (VEP) anormalliklere neden olabilmektedir. Bu çalışmada OCT ile Retina Sinir Lifi Tabakası (RSLT), Ganglion Hücre Kompleksi (GCC) ve maküler kalınlığı ölçülerek, bu parametreler, klinik olarak ON öyküsü olan ve olmayan MS hastaları ve sağlıklı bireylerle karşılaştırıldı. Ayrıca bu değerlerin VEP bulguları ve klinik bulgularla korelasyonunun olup olmadığı incelendi, aksonal kaybın bir belirteci olarak kullanılıp kullanılamayacağını değerlendirme hedeflendi. Yöntem: Çalışmaya 18-55 yaşları arasında, 49 MS hastası (98 göz) ve 30 sağlıklı kontrol grubu (60 göz) dahil edildi. Görme keskinliği, renkli görme, VEP ve OCT ölçümü yapıldı. Bulgular: ON öyküsü olan gözlerde daha fazla olmak üzere tüm MS hastalarında RNFL, GCC, makula (süperior dış katman hariç) ve fovea kalınlığı ölçümleri istatistiksel olarak anlamlı olarak daha ince bulundu. Sonuç: ON olmayan gözlerde de bu değerlerde bozulma tespit edilmesi OCT’nin sadece ON geçiren MS hastalarında değil tüm hastalarda kullanılmasının fayda sağlayacağını ve OCT de bakılan parametre sayısı artırıldıkça ayırt edici özelliğinin artacağını ve aksonal hasarın MS hastalarında daha iyi değerlendirebileceğini düşündürdü.

Anahtar Kelimeler:

Multipl Skleroz, Maküla, Retina Ganglion Hücresi

Is there a relationship between the ganglion cell complex thickness and macular thickness in patients with multiple sclerosis?

Objective: Optic neuritis (ON) is the most common ocular finding of multiple sclerosis (MS). ON can cause axonal loss and abnormalities in both optical coherence tomography (OCT) parameters and visual evoked potentials (VEPs). In this study, the retinal fiber layer (RNFL), ganglion cell complex (GCC) and macular thicknesses were measured with OCT and compared between MS cases with and without a clinical history of ON and healthy individuals. In addition, it was examined whether these values were correlated with VEP and clinical findings and whether they could be used as a marker of axonal loss. Method: The study included 49 patients with MS (98 eyes) and 30 healthy controls (60 eyes) aged 18-55 years. Visual acuity, color vision, VEP, and OCT measurements were evaluated. Results: RNFL, GCC, macula (except the superior outer layer), and foveal thickness measurements were statistically significantly thinner in all MS patients, especially in eyes with a history of ON. Conclusion: Due to the detection of deterioration in these values in non-ON eyes, it was concluded that the use of OCT in all patients, not only in MS patients with ON, would be beneficial, and as the number of parameters measured in OCT is increased, its distinctive feature will improve and axonal damage can be better evaluated in MS patients.

Keywords:

Multiple Sclerosis, Macula, Retinal Ganglion Cell,

PDF

___

Francis DA, Compston DAS, Batchelor JR, McDonald WI. A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up. J Neurol Neurosurg Psychiatry. 1987;50(6):758-65. https://doi.org/10.1136/jnnp.50.6.758
Söderström M, Ya-Ping J, Hillert J, Link H. Optic neuritis: Prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50(3):708-14. https://doi.org/10.1212/WNL.50.3.708
Sherif M, Bergin C, Borruat FX. Normal Visual Recovery after Optic Neuritis Despite Significant Loss of Retinal Ganglion Cells in Patients with Multiple Sclerosis. Klin Monbl Augenheilkd. 2019;236(4):425-8. https://doi.org/10.1055/a-0853-1721
Petzold A, Boer JF, Schippling S, Vermersch P, Kardon R et al. Optical coherence tomography in multiple sclerosis: A systematic review and meta-analysis. Lancet Neurol. 2010;9(9):921-32. https://doi.org/10.1016/S1474-4422(10)70168-X
Kallenbach K, Frederiksen J. Optical coherence tomography in optic neuritis and multiple sclerosis: A review. Eur J Neurol. 2007;14(8):841-9. https://doi.org/10.1111/j.1468-1331.2007.01736.x
Chatziralli IP, Moschos MM, Brouzas D, Kopsidas K, Ladas ID. Evaluation of retinal nerve fibre layer thickness and visual evoked potentials in optic neuritis associated with multiple sclerosis. Clin Exp Optom. 2012;95(2):223-8. https://doi.org/10.1111/j.1444-0938.2012.00706.x
Huang D, Swanson E a, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical Coherence. 1991;1-4.
Birkeldh U, Manouchehrinia A, Hietala MA, Hillert J, Olsson T, Piehl F, et al. The temporal retinal nerve fiber layer thickness is the most important optical coherence tomography estimate in multiple sclerosis. Front Neurol. 2017;8(DEC). https://doi.org/10.3389/fneur.2017.00675
Costello F, Coupland S, Hodge W, Lorello GR, Koroluk J, Pan YI, et al. Quantifying axonal loss after optic neuritis with optical coherence tomography. Ann Neurol. 2006;59(6):963-9. https://doi.org/10.1002/ana.20851
Rebolleda G, Noval S, Contreras I, Arnalich-Montiel F, García Perez JL, Mũoz-Negrete FJ. Optic disc cupping after optic neuritis evaluated with optic coherence tomography. Eye. 2009;23(4):890-4. https://doi.org/10.1038/eye.2008.117
Bsteh G, Berek K, Hegen H, Altmann P, Wurth S, Auer M, et al. Macular ganglion cell-inner plexiform layer thinning as a biomarker of disability progression in relapsing multiple sclerosis. Mult Scler J. 2021;27(5):684-94. https://doi.org/10.1177/1352458520935724
Parisi V, Manni G, Spadaro M, Colacino G, Restuccia R, Marchi S, et al. Correlation between morphological and functional retinal impairment in multiple sclerosis patients. Investig Ophthalmol Vis Sci. 1999;40(11):2520-7.
Laura Fernández Blanco, Manuel Marzin, Alida Leistra, Paul van der Valk, Erik Nutma, Sandra Amor. Immunopathology of the optic nerve in multiple sclerosis. Clin Exp Immunol. 2022;209(2):236-246. https://doi.org/10.1093/cei/uxac063
Britze J, Frederiksen JL. Optical coherence tomography in multiple sclerosis. Eye. 2018;32(5):884-8. https://doi.org/10.1038/s41433-017-0010-2
Fisher JB, Jacobs DA, Markowitz CE, Galetta SL, Volpe NJ, Nano Schiavi ML, et al. Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis. Ophthalmology. 2006;113(2):324-32. https://doi.org/10.1016/j.ophtha.2005.10.040
Guerrieri S, Comi G, Leocani L. Optical Coherence Tomography and Visual Evoked Potentials as Prognostic and Monitoring Tools in Progressive Multiple Sclerosis. Front Neurosci. 2021;15(August):1-10. https://doi.org/10.3389/fnins.2021.692599
Trip SA, Schlottmann PG, Jones SJ, Li WY, Garway-Heath DF, Thompson AJ, et al. Optic nerve atrophy and retinal nerve fibre layer thinning following optic neuritis: Evidence that axonal loss is a substrate of MRI-detected atrophy. Neuroimage. 2006;31(1):286-93. https://doi.org/10.1016/j.neuroimage.2005.11.051
Lotfy NM, Alasbali T KR. Macular ganglion cell complex parameters by optical coherence tomography in cases of multiple sclerosis without optic neuritis compared to healthy eyes. Indian J Ophthalmol. 2019;67(5):648-53. https://doi.org/10.4103/ijo.IJO_1378_18
Özbilen KT, Gündüz T, Çukurova Kartal SN, Aksu Ceylan N, Eraksoy M, Kürtüncü M. Detailed evaluation of macular ganglion cell complex in patients with multiple sclerosis. Noropsikiyatri Ars. 2021;58(3):176-83. https://doi.org/10.29399/npa.27531
Hu SJ, You YA, Zhang Y. A study of retinal parameters measured by optical coherence tomography in patients with multiple sclerosis. Int J Ophthalmol. 2015;8(6):1211-4.
Burkholder BM, Osborne B, Loguidice MJ, Bisker E, Frohman TC, Conger A, et al. Macular volume determined by optical coherence tomography as a measure of neuronal loss in multiple sclerosis. Arch Neurol. 2009;66(11):1366-72. https://doi.org/10.1001/archneurol.2009.230
Hood DC, Fortune B, Arthur SN, Xing D, Salant JA, Ritch R, et al. Blood vessel contributions to retinal nerve fiber layer thickness profiles measured with optical coherence tomography. J Glaucoma. 2008;17(7):519-28. https://doi.org/10.1097/IJG.0b013e3181629a02
Chua J, Bostan M, Li C, Sim YC, Bujor I, Wong D, et al. A multi regression approach to improve optical coherence tomography diagnostic accuracy in multiple sclerosis patients without previous optic neuritis. NeuroImage Clin. 2022;34(August 2021). https://doi.org/10.1016/j.nicl.2022.103010
Uzunköprü C, Yüceyar N, Güven Yilmaz S, Afrashi F, Ekmekçi Ö, Taşkiran D. Retinal nerve fiber layer thickness correlates with serum and cerebrospinal fluid neurofilament levels and is associated with current disability in multiple sclerosis. Noropsikiyatri Ars. 2021;58(1):34-40. https://doi.org/10.29399/npa.27355
Grecescu M. Optical coherence tomography versus visual evoked potentials in detecting subclinical visual impairment in multiple sclerosis. J Med Life. 2014;7(4):538-41.
Naismith RT, Tutlam NT, Xu J, Shepherd JB, Klawiter EC, Song SK, et al. Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis. Neurology. 2009;73(1):46-52. https://doi.org/10.1212/WNL.0b013e3181aaea32
Costello F, Pan YI, Yeh EA, Hodge W, Burton JM, Kardon R. The temporal evolution of structural and functional measures after acute optic neuritis. J Neurol Neurosurg Psychiatry. 2015;86(12):1369-73. https://doi.org/10.1136/jnnp-2014-309704