The Detection of Retina Microvascular Density in Subclinical Aquaporin-4 Antibody Seropositive Neuromyelitis Optica Spectrum Disorders

Abstract

Purpose: To use optical coherence tomography (OCT) and OCT angiography (OCT-A) to measure changes in the retinal structure and microvasculature of patients with aquaporin-4 antibody-positive, neuromyelitis optica spectrum disorder (NMOSD) with a history of optic neuritis (NMOSD+ON) and those without it (NMOSD-ON). Methods: A total of 27 aquaporin-4 antibody-positive NMOSD patients and 31 age-and gender-matched healthy control (HC) participants were included. In 27 NMOSD patients, 19 of them had a history of optic neuritis (ON) and 8 of them had no history of ON. Peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell and inner plexiform layer (GCIPL) thickness were measured by OCT. Radial peripapillary capillary density (RPCD) and macular superficial vessel density (MSVD) were measured by OCT-A. Comparisons of retinal structural and microvascular parameters between the cohorts were performed using generalized estimating equation (GEE) models. Diagnostic accuracy was evaluated by the area under the receiver operating characteristics curve (AROC). Results: In NMOSD+ON eyes, the GCIPL and pRNFL thicknesses, 48.6 ± 7.1 and 61.7 ± 25.1 µm, respectively, were significantly thinner than in HC eyes (P < 0.001 for both). However, in NMOSD-ON eyes, the GCIPL and pRNFL thicknesses were not significantly thinner than in HC eyes (P > 0.05 for both). In NMOSD+ON eyes, the RPCD and MSVD, 37.8 ± 7.1 and 36.7 ± 5.0%, respectively, were significantly less dense than HC eyes (P < 0.001 for both). Similarly, the RPCD and MSVD in NMOSD-ON eyes, 49.0 ± 2.8 and 43.9 ± 4.2%, respectively, were also less dense than in HC eyes (P < 0.029 for RPCD, P < 0.023 for MSVD). The highest AROC, 0.845 (sensitivity = 88.5%, specificity = 78.0%), was achieved by the logistic regression combination of all of the variables, i.e., pRNFL, GCIPL, RPCD, and MSVD. Conclusions: Retinal microvascular changes were present in NMOSD-ON eyes. The combination of retinal structural and microvascular parameters might be helpful to discriminate NMOSD-ON eyes from HC eyes.

RETRACTED: Retinal microvasculature alterations in neuromyelitis optica spectrum disorders before optic neuritis

“…NMOSD patients and healthy controls to determine whether primary microvascular pathology presents in NMOSD and to evaluate the clinical importance of macula capillaries as a measure of neuronal status. Our data showed that the macula densities of NMOSD with and without optic neuritis were significantly reduced than that of controls which is congruent with the previous reports (Chen et al, 2020;Kwapong et al, 2018;Mansoori et al, 2017). Our report suggests that these structural and microvascular changes of the retina are structural indicators of NMOSD before the occurrence of optic neuritis.…”

“…Recent reports (Chen et al, 2020;Huang et al, 2019) on the macula microvasculature of NMOSD patients showed significantly reduced and slightly reduced macular density and RPC density in eyes with optic neuritis and eyes without optic neuritis respectively. The authors suggested that retinal microvascular changes occur in the subclinical phase of NMOSD and microvascular damage plays a pivotal role in the pathogenesis of NMOSD.…”

“…Reports have shown that NMOSD patients have significantly reduced peripapillary retinal nerve fiber layer (pRNFL) after optic neuritis indicating a significant axonal loss after ON (Chen et al, 2020;Huang et al, 2019). As such pRNFL has been recognized as a structural biomarker for neuroaxonal damage and has been reported to correlate with visual impairment in NMOSD (Oertel et al, 2017).…”

“…This imaging tool provides high-resolution data on the multiple vascular plexuses of the retina. A recent report has shown that the vascular damage that occurs in NMOSD and have shown its association with clinical data (Chen et al, 2020;Huang et al, 2019). Nonetheless, the microvasculature changes in the multiple microvascular plexus of the retina and its association with the disease pathology are less explored.…”

Macular vessel density differs in multiple sclerosis and neuromyelitis optica spectrum disorder: an optical coherence tomography angiography study.

“…In contrary to MS-ON group, the NMOSD-ON eyes had comparable SCP, DCP, and GCC parameters to controls. In the studies of Huang et al and Chen et al, the vessel density was measured only in SCP, and in NMOSD + ON and NMOSD-ON patients, they found it lower than in healthy eyes 13,16 . Kwapong et al presented that, besides the reduced density of SCP, the density of DCP was also reduced in ON and non-ON eyes 15 .…”