UID835296
阅读权限20
专业分
贡献分
爱医币
鲜花
注册时间2008-11-14
|
Brain 2008 131(1):277-287; doi:10.1093/brain/awm285
An investigation of the retinal nerve fibre layer in progressive multiple sclerosis using optical coherence tomography
一项进展性多发性硬化视网膜神经纤维层视觉相干X断层扫描的研究
Andrew P. D. Henderson1,2, S. Anand T**1,2, Patricio G. Schlottmann4, Daniel R. Altmann1,3, David F. Garway-Heath4, Gordon T. Plant2 and David H. Miller1
1NMR Research Unit, Institute of Neurology, University College London, London, WC1N 3BG, 2Department of Neuro-Ophthalmology, Moorfields Eye Hospital, City Road, 3Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street and 4Glaucoma Research Unit, Moorfields Eye Hospital, City Road, London, UK
Correspondence to: Dr Andrew Henderson, NMR Research Unit, Institute of Neurology, University College London, London, WC1N 3BG, UK E-mail: a.henderson@ion.ucl.ac.uk
Axonal loss is thought to be the predominant cause of disability in progressive multiple sclerosis (MS). The retinal nerve fibre layer (RNFL) is composed largely of unmyelinated axons of retinal ganglion cells, and is accessible to study with optical coherence tomography (OCT), giving a measure of axonal loss. OCT measures of the RNFL thickness (RNFLT) and macular volume were studied in 23 patients with primary progressive multiple sclerosis (primary progressive MS) (13 male; 10 female; mean age 52 years; median EDSS 6.0; mean disease duration 11 years), and 27 patients with secondary progressive multiple sclerosis (secondary progressive MS) (8 male; 19 female; mean age 50 years; median EDSS 6; mean disease duration 22 years). Of the patients with secondary progressive MS, 14 had clinical history of optic neuritis (ON) in a single eye; the remaining patients had not had ON. Twenty healthy controls (11 male; 9 female; mean age 46 years) had RNFLT and macular volume studied. Of the patients’ eyes not previously affected by ON, both the mean RNFL thickness and macular volume were reduced when compared with control values. The mean RNFL thickness and macular volume were significantly reduced in secondary progressive MS, but not in primary progressive MS when compared with control RNFL thickness and macular volume. RNFL loss was most evident in the temporal quadrant, where significant reduction was seen in primary progressive MS versus controls and in secondary versus primary progressive MS. There were significant correlations of decreased RNFLT and macular volume with measures of visual acuity, low contrast visual acuity and visual field mean deviation in the MS patients. There are significant global reductions in RNFLT and macular volume in the eyes of secondary progressive MS patients not previously affected by ON, but not in primary progressive MS patients, compared with controls. This may indicate a difference in the extent of the pathological processes that cause axonal loss in the retina, and by inference the optic nerve, in secondary progressive MS and primary progressive MS.
轴突缺失被认为是进展性多发性硬化残疾形成的首当其冲的原因。视网膜神经纤维层大致由视网膜神经节细胞的无髓轴突组成,并且可以用视觉相干X线断层扫描(OCT)的方法来研究,可测定轴突的缺失。研究了 23名原发进展性多发性硬化患者中的OCT 测定的视网膜神经纤维厚度和黄斑体积, (13 男; 10 女; 平均年龄 52 岁; 平均 EDSS 6.0; 平均患病时间11 年), 以及27名继发的进展性多发性硬化患者(8 男; 19 女; 平均年龄 50 岁; 平均 EDSS 6; 平均患病时间22 年) 在继发的进展性多发性硬化患者中,14名有单眼的视神经炎临床病史;其余患者无视神经炎临床病史。20名健康对照组(11 男; 9女; 平均年龄 46岁) 进行了视网膜神经纤维层和黄斑面积扫描研究。在没有感染过视神经炎的患者中,平均视网膜神经纤维层的厚度和黄斑面积值均低于健康对照组。 继发性进展性多发性硬化患者平均视网膜神经纤维层的厚度和黄斑面积值亦降低,但与原发性进展性多发性硬化相比不降低。视网膜神经纤维层的缺失在颞象限最为明显,在原发性进行性多发性硬化与继发性进行性多发性硬化相比时降低显著。 减少的视网膜神经纤维层和黄斑面积与视觉准确度有明显的相关性,低的视觉对比准确度和视野均差在多发性硬化患者中为低。在未感染视神经炎的继发性的多发性硬化患者眼球视网膜神经纤维的缺失和黄斑面积的降低,但不是在原发进展性多发性硬化患者,与正常对照组相比。 此结果提示原发性和继发性进展性多发性硬化患者,引起视网膜轴突缺失的病理过程程度,及由此推出视神经的病变之间的差异。
请指教! |
|