Optical coherence tomography and angiography evaluates retina and vascular density in aquaporin-4 antibody positive neuromyelitis optica spectrum disorders
Objective Using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)to evaluate changes in retinal structure and vascular density in neuromyelitis optica spectrum disorders(NMOSD),and exploring their correlation with clinical disease features.Methods This study enrolled 42 NMOSD patients with aquaporin-4 antibody positive(84 eyes)and 45 healthy controls(90 eyes).Based on the history of optic neuritis(ON),the NMOSD group was further divided into two groups:NMOSD patients with a history of ON(NMOSD+ON group)and those without a history of ON(NMOSD-ON group).OCT and OCTA were used to obtain measurements of the ganglion cell complex(GCC),the retinal nerve fiber layer(RNFL),the superficial capillary plexus(SCP),the deep capillary plexus(DCP),and the vascular density of the optic disc area.NMOSD duration and number of episodes,best corrected visual acuity(BCVA),and Expanded Disability Status Scale(EDSS)scores were recorded to analyze the correlation between these indicators and OCT and OCTA parameters.Results Structural changes in the macula and optic disc:Compared with the control group,the overall RNFL thickness and temporal(TEM),superior(SUP),nasal(NAS)and inferior(INF)RNFL thickness in the NMOSD+ON group were significantly decreased(P＜0.05).The overall RNFL thickness and SUP RNFL thickness in the NMOSD-ON group were significantly decreased(P＜0.05).Compared with the NMOSD-ON group,the overall RNFL thickness and TEM,SUP,NAS and INF RNFL thickness in the NMOSD+ON group were significantly decreased(P＜0.05).Compared with the control group,the GCC thickness of overall,SUP and INF in the NMOSD+ON group was significantly decreased(P＜0.05).The overall and SUP GCC thickness of NMOSD-ON group was significantly lower than that of the control group(P＜0.05).Compared with NMOSD-ON group,the GCC thickness of overall,SUP and INF in NMOSD+ON group was significantly decreased(P＜0.05).Comparison of macular vessel density:compared with the control group,the vessel density of SCP overall,foveal,parafoveal TEM,SUP,NAS,INF regions,and perifoveal TEM,SUP,NAS,INF regions in the NMOSD+ON group decreased significantly(P＜0.05).Compared with the control group,the overall vessel density of DCP and the vessel density of parafoveal TEM,SUP,NAS,INF regions and perifoveal TEM,SUP,NAS,INF regions were significantly reduced in the NMOSD-ON group(P＜0.05).Compared with the NMOSD-ON group,the overall vessel density of SCP and parafoveal TEM,SUP and INF,perifoveal TEM,SUP,NAS and INF vessel densities were significantly decreased in the NMOSD+ON group(P＜0.05).The vessel density in the DCP fovea,parafoveal NAS and perifoveal TEM areas was significantly increased in the NMOSD+ON group(P＜0.05).Comparison of the vessel density in the optic disc area:compared with the control group,the vessel density in the overall optic disc area and in and around the optic disc area of nasal superior region(NS),nasal inferior region(NI),inferior nasal region(IN),inferior temporal region(IT),temporal inferior region(TI),temporal superior region(TS),superior temporal region(ST),and superior nasal region(SN)in the NMOSD+ON group was significantly decreased(P＜0.05).Compared with NMOSD-ON group,there was no difference in the vessel density of the optic disc in NMOSD+ON group(P=0.268),but the vessel density of the overall optic disc area and para-optic disc area was significantly decreased(P＜0.05).The course of disease was negatively correlated with GCC thickness,RNFL thickness,SCP vessel density and radial peripheral capillaries(RPC)vessel density(respectively,r=-0.436,P＜0.001;r=-0.337,P=0.002;r=-0.325,P=0.003;r=-0.239,P=0.028)in NMOSD group.The frequency of onset was negatively correlated with RNFL thickness and RPC vessel density(respectively,r=-0.360,P=0.001;r=-0.315,P=0.004).BCVA was negatively correlated with GCC thickness(r=-0.303,P=0.005).Conclusions Retinal structures and retinal vasculature damage was present in both eyes with and without ON in patients with NMOSD,and the damage was more severe in patients with longer disease duration and more episodes.SCP density was reduced in eyes with ON compared with eyes without ON.
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