| Primary retinal pathology in multiple sclerosis as detected by optical coherence tomography. | |
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MedLine Citation:
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PMID: 21252110 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Optical coherence tomography studies in multiple sclerosis have primarily focused on evaluation of the retinal nerve fibre layer. The aetiology of retinal changes in multiple sclerosis is thought to be secondary to optic nerve demyelination. The objective of this study was to use optical coherence tomography to determine if a subset of patients with multiple sclerosis exhibit primary retinal neuronopathy, in the absence of retrograde degeneration of the retinal nerve fibre layer and to ascertain if such patients may have any distinguishing clinical characteristics. We identified 50 patients with multiple sclerosis with predominantly macular thinning (normal retinal nerve fibre-layer thickness with average macular thickness < 5th percentile), a previously undescribed optical coherence tomography defined phenotype in multiple sclerosis, and compared them with 48 patients with multiple sclerosis with normal optical coherence tomography findings, 48 patients with multiple sclerosis with abnormal optical coherence tomography findings (typical for multiple sclerosis) and 86 healthy controls. Utilizing a novel retinal segmentation protocol, we found that those with predominant macular thinning had significant thinning of both the inner and outer nuclear layers, when compared with other patients with multiple sclerosis (P < 0.001 for both), with relative sparing of the ganglion cell layer. Inner and outer nuclear layer thicknesses in patients with non-macular thinning predominant multiple sclerosis were not different from healthy controls. Segmentation analyses thereby demonstrated extensive deeper disruption of retinal architecture in this subtype than may be expected due to retrograde degeneration from either typical clinical or sub-clinical optic neuropathy. Functional corroboration of retinal dysfunction was provided through multi-focal electroretinography in a subset of such patients. These findings support the possibility of primary retinal pathology in a subset of patients with multiple sclerosis. Multiple sclerosis-severity scores were also significantly increased in patients with the macular thinning predominant phenotype, compared with those without this phenotype (n = 96, P=0.006). We have identified a unique subset of patients with multiple sclerosis in whom there appears to be disproportionate thinning of the inner and outer nuclear layers, which may be occurring as a primary process independent of optic nerve pathology. In vivo analyses of retinal layers in multiple sclerosis have not been previously performed, and structural demonstration of pathology in the deeper retinal layers, such as the outer nuclear layer, has not been previously described in multiple sclerosis. Patients with inner and outer nuclear layer pathology have more rapid disability progression and thus retinal neuronal pathology may be a harbinger of a more aggressive form of multiple sclerosis. |
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Authors:
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Shiv Saidha; Stephanie B Syc; Mohamed A Ibrahim; Christopher Eckstein; Christina V Warner; Sheena K Farrell; Jonathan D Oakley; Mary K Durbin; Scott A Meyer; Laura J Balcer; Elliot M Frohman; Jason M Rosenzweig; Scott D Newsome; John N Ratchford; Quan D Nguyen; Peter A Calabresi |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2011-01-20 |
Journal Detail:
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Title: Brain : a journal of neurology Volume: 134 ISSN: 1460-2156 ISO Abbreviation: Brain Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-31 Completed Date: 2011-04-11 Revised Date: 2011-12-20 |
Medline Journal Info:
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Nlm Unique ID: 0372537 Medline TA: Brain Country: England |
Other Details:
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Languages: eng Pagination: 518-33 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. calabresi@jhmi.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Electroretinography / methods Female Humans Male Middle Aged Models, Biological Multiple Sclerosis / complications, diagnosis, pathology*, physiopathology Optic Nerve / pathology, physiopathology Retina / pathology*, physiopathology Retinal Diseases / complications, pathology* Retrograde Degeneration / pathology, physiopathology Severity of Illness Index Tomography, Optical Coherence / methods* Vision, Ocular / physiology |
| Comments/Corrections | |
Comment In:
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Brain. 2011 Nov;134(Pt 11):e193; author reply e194
[PMID:
21596763
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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