Retinal and Choriocapillary Vascular Changes in Early Stages of Multiple Sclerosis: A Prospective Study

Abstract

Optical Coherence Tomography Angiography (OCTA) abnormalities occur in multiple sclerosis (MS) over the course of the disease. OCTA investigations at early MS stages are lacking. We aimed to investigate vessel density in macular and papillary regions over two years after an initial demyelinating event (IDE). Vessel density was analyzed in superficial, deep, choriocapillaris and radial peripapillary plexus at baseline, and after one and two years. We also evaluated structural OCT parameter changes of the ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL). We evaluated 30 eyes from 15 IDE patients (7 females, 8 males, mean age 28.4 ± 9.6 years) and 30 eyes from 15 healthy controls. After 2 years, we reported in the IDE group a reduced vessel density in the superficial capillary plexus, deep capillary plexus and radial peripapillary capillary plexus with respect to the baseline (coeff. β = −2.779, p = 0.013; coeff. β = −4.055, p = 0.018 and coeff. β = −2.687, p ≤ 0.001; respectively), while GCC and RNFL thicknesses did not change. Vessel density reduction was not associated with an expanded disability status scale (EDSS) change, relapse occurrence or magnetic resonance imaging activity. The analysis of healthy controls did not reveal any impairment in OCT and OCTA parameters over 2 years of follow-up. Retinal vascular loss occurs in patients with an IDE independently from clinical and radiological disease activity. Retinal vessel density could represent a novel early biomarker to monitor the MS pathological burden.

Microvascular impairments detected by optical coherence tomography angiography in multiple sclerosis patients: A systematic review and meta-analysis

“…Therefore, we combined these results into a single study. Ultimately, this meta-analysis included 13 studies with 996 MS eyes and 847 HC eyes (Lanzillo et al, 2018;Feucht et al, 2019;Cennamo et al, 2020;Cordon et al, 2020;Farci et al, 2020;Murphy et al, 2020;Ulusoy et al, 2020;Yilmaz et al, 2020;Aly et al, 2021;Kallab et al, 2021;Khader et al, 2021;Montorio et al, 2021;Rogaczewska et al, 2021a,b). Murphy et al (2020) reported the results…”

“…stratified by image artifact grading, and we only included the data of minimal artifact in the quantitative analysis of meta-analysis. Among 13 included studies, four studies (Cordon et al, 2020;Farci et al, 2020;Kallab et al, 2021;Khader et al, 2021) analyzed monocular data, whereas nine studies (Lanzillo et al, 2018;Feucht et al, 2019;Cennamo et al, 2020;Murphy et al, 2020;Ulusoy et al, 2020;Yilmaz et al, 2020;Aly et al, 2021;Montorio et al, 2021;Rogaczewska et al, 2021a,b) analyzed biocular data. For patients with MS, the mean illness duration ranged from 4 to 11 years and the mean EDSS scores ranged from 1.0 to 3.5.…”

“…All pooled estimates are summarized in Table 2. Eleven studies (Lanzillo et al, 2018;Feucht et al, 2019;Cennamo et al, 2020;Cordon et al, 2020;Farci et al, 2020;Murphy et al, 2020;Ulusoy et al, 2020;Yilmaz et al, 2020;Aly et al, 2021;Montorio et al, 2021;Rogaczewska et al, 2021b), which included 1,455 eyes, reported data on the vessel density of the SVC (Supplementary Figure 1). The SVC density was reduced by 2.27% (95% CI −3.12 to −1.43%, P < 0.01) and 4.30% (95% CI −5.27 to −3.33%, P < 0.01) in the MSNON and MSON groups, respectively, compared with that in the HC group.…”

“…Nine studies (Feucht et al, 2019;Cennamo et al, 2020;Farci et al, 2020;Murphy et al, 2020;Ulusoy et al, 2020;Yilmaz et al, 2020;Aly et al, 2021;Montorio et al, 2021;Rogaczewska et al, 2021b), which included 1,038 eyes, reported data on the vessel density of the DVC (Supplementary Figure 2). No significant difference in the DVC density was found between the MSNON and HC groups (MD = −0.79%, P = 0.21).…”

Optical Coherence Tomography and Optical Coherence Tomography with Angiography in Multiple Sclerosis

“…Studies have also identified OCT-A as a potential tool for monitoring disease progression. Recent data suggest that marked vascular loss in the SVP, DVP, and pRPC may be observed in people with an initial demyelinating event, although no changes might occur in the RNFL, GC-IPL thickness, or clinical and radiological examinations [ 59 ].…”