Otoimmün Demiyelinizan Hastalıklara Bağlı Optik Nörit Geçiren Olgularda Optik Sinir ile Makula Fonksiyonunun Değerlendirilmesi

Abstract

Introduction and Aim: Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are autoimmune demyelinating disorders of the central nervous system that frequently present with attacks of optic neuritis (ON). The aim of this study was to comprehensively and quantitatively evaluate the structural, vascular, electrophysiological, and functional characteristics of the optic nerve and macula in patients with ON associated with autoimmune demyelinating diseases, and to investigate both clinical and subclinical manifestations of damage in comparison with healthy controls. Materials and Methods: A total of 191 patients (382 eyes) were included in the study. Eyes were classified into four groups: eyes with a history of ON (n=130), fellow eyes of patients with previous ON (n=38), eyes of patients with demyelinating disease but no history of ON (n=46), and healthy control eyes (n=168). Macular function was assessed using microperimetry (MP), while structural, vascular, and electrophysiological evaluations were performed using optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), and pattern electroretinography (PERG), respectively. Generalized estimating equations (GEE) were used to account for within-subject correlation arising from bilateral eye data, and the models were adjusted for age and sex. Bonferroni and Benjamini–Hochberg false discovery rate (FDR) corrections were applied for multiple comparisons. Results: The mean retinal sensitivity on MP was significantly lower in eyes with previous ON, fellow eyes of patients with previous ON, and eyes of patients with demyelinating disease without a history of ON compared with healthy controls (all p<0.001). On OCT, ganglion cell layer plus inner plexiform layer (GCL+IPL) thickness was significantly reduced in eyes with previous ON and in fellow eyes compared with controls (both p<0.001), whereas no significant difference was observed in eyes without a history of ON. Mean peripapillary retinal nerve fiber layer (RNFL) thickness was significantly lower in eyes with previous ON, fellow eyes, and eyes without a history of ON compared with controls (p<0.001, p<0.001, and p=0.005, respectively). OCTA analysis demonstrated that the outer-region percentile of the radial peripapillary capillary network surrounding the optic nerve head was significantly lower in eyes with previous ON and in fellow eyes than in controls (both p<0.001). Macular superficial vessel density was significantly reduced in eyes with previous ON, fellow eyes, and eyes without a history of ON compared with controls (all p<0.001). On PERG assessment, N95 amplitude and the N95/P50 ratio were significantly lower in eyes with previous ON than in controls (p=0.014 and p<0.001, respectively). Conclusion: In autoimmune demyelinating diseases, neuronal, vascular, and functional involvement associated with optic neuritis is not confined to eyes with clinically overt ON, but is also detectable in fellow eyes and in eyes of patients with demyelinating disease without a history of ON. Combined assessment of structural, vascular, electrophysiological, and functional parameters may be valuable for monitoring disease-related neurodegenerative changes and identifying subclinical involvement.