MULTİPL SKLEROZ HASTALARINDA OPTİK KOHERANS TOMOGRAFİ VE HEIDELBERG RETİNAL TOMOGRAFİ İLE RETİNA SİNİR LİFİ TABAKASI ANALİZİ: GÖRSEL UYARTILMIŞ POTANSİYELLER VE FONKSİYONEL DİZABİLİTE İLE KARŞILAŞTIRM

Öz

Multipl Skleroz MS , merkezi sinir sisteminin yaygın demiyelinizan lezyonları ile karakterize kronik bir hastalıktır. MS hastalarında ortaya çıkan özürlülük, demiyelinizasyon ve aksonal hasar ile yakından ilişkilidir. MS hastalarında, optik Koherans Tomografi OKT ve Heidelberg Retina Tomografisi HRT yöntemleri ile retinanın incelenmesi, bize merkezi sinir sisteminin miyelinsiz aksonlarını doğrudan değerlendirme imkanı sunar. Bu çalışma ile MS hastalarının retinal sinir lifi tabakası kalınlığı RSLT ile görsel uyartılmış potansiyeller VEP ve özürlülük arasındaki ilişkiyi ortaya koymak amaçlanmıştır. MS tanılı 41 hasta ile yaş ve cinsiyete göre eşleştirilmiş 20 sağlıklı gönüllü çalışmaya dahil edildi. Toplam 41 MS hastasının 82 gözü ile 20 sağlıklı bireyin 40 adet gözü değerlendirildi. MS hasta grubunda, OKT’den en az 6 ay öncesinde tek veya iki taraflı optik nörit atağı geçiren 8 MS hastası vardı. Hasta ve kontrol grubunda; genişletilmiş özürlülük durum ölçeği EDSS hesaplandı, VEP analizleri, OKT ve HRT ölçümleri yapıldı. MS hasta grubunda, OKT ve HRT ile ölçülen RSLT kalınlığı, kontrol grubu ile karşılaştırıldığında istatistiksel olarak anlamlı derecede azalmış olarak saptandı. OKT ile ölçülen RSLT kalınlığı ile VEP P100 değerleri ve EDSS arasında korelasyon saptadık.HRT ile yapılan RSLT kalınlığı ölçümü ve VEP P100 dalga latansı arasında ise benzer ilişki saptanmadı. Optik nörit atağı olan ve olmayan tüm MS hastalarında, OKT ve HRT ile ölçülen RSLT kalınlığında azalma saptandı. OKT ve HRT, MS hastalarında aksonal hasarın erken yapısal biyomarkırı olarak kullanılabilir

Anahtar Kelimeler

• Multipl skleroz,retina sinir lifi tabakası,görsel uyartılmış potansiyeller,optik koherans tomografi,Heidelberg Retinal Tomografi

RETINAL NERVE FIBER LAYER ANALYSIS BY OPTICAL COHERENCE TOMOGRAPHY AND HEIDELBERG RETINAL TOMOGRAPHY: COMPARISON WITH VISUAL EVOKED POTENTIALS AND FUNCTIONAL DISABILITY IN MULTIPLE SCLEROSIS PATIENTS

Abstract

Multiple sclerosis MS is a chronic disease which is characterised by widespread demyelinated lesions in the central nervous system CNS . Disability from MS, is strongly associated with demyelination and axonal involvement. In MS patients, evaluation of retina by optic coherence tomography OCT and Heidelberg Retinal Tomography HRT methods gives us the possibility to visualize unmyelinated axons of the CNS directly. In this study, we aim to object to the relationship between retinal nerve fiber layer RNFL thickness and visual evoked potentials VEP and the disability scores in MS patients. 41 patients with MS and 20 healthy, age and sex matched volunteers were included. 82 eyes of 41 patients with MS and 40 eyes of 20 healthy individuals were assesed. In MS patients group, 8 of them had unilateral or bilateral previous optic neuritis at least 6 months before OCT. In MS patients and control group; the EDSS, VEP analysis, OCT and HRT measurements were performed. The OCT and HRT measured RNFL thickness was statistically diminished significantly in MS patients compared to the control group. Furthermore, we showed a correlation between reduced RNFL values obtained with OCT and prolonged P100 latencies by VEP analysis and EDSS scale. On the contrary, there was no correlation between HRT measured RNFL thickness and P100 wave latencies. All MS patients with or without previous optic neuritis showed RNFL atrophy measured by OCT and HRT. OCT and HRT could be used as an early structural biomarker of axonal damage in MS patients

Keywords

• Multiple sclerosis,retinal nerve fiber layer,visual evoked potentials,optic coherence tomography,Heidelberg retinal tomography

Kaynakça

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