Optic neuritis, multiple sclerosis-related or not: Structural and functional study

Oreja-Guevara, C.; Noval, S.; Manzano, B.; Diez-Tejedor, E.

doi:10.1016/S2173-5808(10)70016-X

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Abstract

Introduction

Multiple sclerosis (MS) is an inflammatory demyelinating disease with axonal degeneration. Optical coherence tomography (OCT) is a noninvasive technique that quantifies the thickness of the retinal nerve fiber layer (RNFL).

Objectives

To determine the thickness of the RNFL in MS patients with or without previous optic neuritis (ON) and in patients with ON and to determine the relationship between the structural damage and functional alterations in visual acuity (VA) and visual field (VF).

Methods

Three groups were studied: G1 - patients with ON, G2 - patients with MS and ON, and G3 - patients with MS and without previous ON. Ophthalmological (VA, VF, OCT) and neurological examinations were performed.

Results

OCT thickness in the unaffected eye was significantly thicker in ON patients (103.99) than in the other groups, however there was no differences among the affected eyes. There were significant differences in VA and VF among the non-affected eyes (p=0.007), but not among the affected eyes (p=0.878).

Conclusions

All MS patients showed axonal damage in both optic nerves, more in patients with previous ON. Axonal damage was detected early, so OCTcould be used as a structural biomarker. Structural damage was related with the functional alterations.

Keywords:

Multiple sclerosis

Optical neuritis

OCT

Optical coherence tomography

Axonal damage

Resumen

Introducción

La esclerosis múltiple (EM) es una enfermedad inflamatoria cuyo sustrato patológico es tanto desmielinizante como axonal. La tomografía de coherencia óptica (TCO) es una técnica cuantitativa que evalúa in vivo el adelgazamiento de la capa de fibras nerviosas de la retina (CFN).

Objetivos

Valorar mediante TCO el estado de la CFN de pacientes con EM con y sin antecedentes de neuritis óptica (NO) y pacientes con sólo NO, así como valorar la repercusión de ésta en la agudeza y los campos visuales.

Métodos

Los pacientes fueron clasificados en tres grupos: a) G1: pacientes con NO; b) G2: pacientes con EM y NO, y c) G3: pacientes con EM sin brotes de NO documentados. A todos se les realizó una exploración oftalmológica que incluía agudeza visual (AV), campimetría (DM) y determinación del grosor de la CFN mediante TCO y una exploración neurológica.

Resultados

El grosor de la CFN en el ojo contralateral es significativamente superior en los pacientes con NO (103,99) que en los otros dos grupos (G2, 85,52; G3, 90,85); sin embargo, no hay diferencias significativas entre ojos afectos. No se encuentran diferencias significativas en AV y DM entre los grupos para el ojo afecto (p=0,878), pero sí para el ojo contralateral (p=0,007).

Conclusiones

En todos los pacientes con EM se evidencia una pérdida axonal en ambos nervios ópticos, que se acentúa en los casos que han sufrido brotes de NO. El daño axonal se detecta tempranamente, con lo que la TCO se podría usar como marcador de integridad axonal. Además, las alteraciones estructurales detectadas por la TCO están en concordancia con las alteraciones en las pruebas funcionales de AV y DM en los ojos afectos.

Palabras clave:

Neuritis óptica

Esclerosis múltiple

Tomografía de coherencia óptica

TCO

Daño axonal

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