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

Yıl 2013, Cilt: 17 Sayı: 4, 258 - 264, 01.12.2013

Serkan Kılınç Memed Acar Hüseyin Aslankara İpek İnci Muhteşem Gedizlioğlu Asli Koskderelioglu

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

• ) Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet. 2002;360:1953-62.
• ) Miller D, Barkhof F, Montalban X, Thompson A, Filippi M. Clinically isolated syndromes
• sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol 2005;4:281-8.
• multiple 3) Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992;326:581-8.
• ) Parisi V, Manni G, Sparado M, Colacino G, Restuccia R, Marchi S, et al. Correlation between morphological and functional retinal impairment in multiple sclerosis patients. Invest Ophthalmol Vis Sci 1999;40:2520-7.
• ) Trip SA, Schlottmann PG, Jones SJ, Altmann
• Thompson AJ,et al. Retinal nerve fiber layer axonal loss and visual dysfunction in 2005;58:383-91. Garway-Heath DF, neuritis. Ann
• Neurol 6) Fisher JB, Jacobs DA, Markowitz CE, Galetta SL, Volpe NJ, Nano-Schiavi ML, et al.Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis. Ophthalmology 2006;113:324- 32.
• ) Noval S, Contreras I, Rebolleda G, Munoz-Negrete FJ. Optical coherence tomography versus automated perimetry for follow up of optic neuritis. Acta Ophthalmol Scand. 2006;84: 790-4.
• ) Costello F, Coupland S, Hodge W, Lorello GR, Koroluk J, Pan YI,et al. Quantifying axonal loss after optic neuritis
• tomography. Ann Neurol. 2006; 59:963- 9. optical
• coherence 9) Trip SA, Schlottmann PG, Jones SJ, Li WY, Garway-Heath DF, Thompson AJ, et al. Optic nerve atrophy and retinal nerve fiber layer thinning following optic neuritis: evidence that axonal loss is a substrate of MRI-detected atrophy. Neuroimage 2006;31: 286-93.
• ) Trip SA, Schlottmann PG, Jones SJ, Li WY, Garway-Heath DF, Thompson AJ, et al. Optic nerve magnetization transfer imaging and measures of axonal loss and demyelination in optic neuritis. Mult Scler 2007;7:875-9.
• ) Sepulcre J, Murie-Fernandez M, Salinas-Alaman A, García-Layana A, Bejarano B, Villoslada P. Diagnostic accuracy of retinal abnormalities in predicting disease activity in MS. Neurology 2007;68:1488-94.
• ) Gordon-Lipkin E, Chodkowski B, Reich DS, Smith SA, Pulicken M, Balcer LJ, et al. Retinal nerve fiber layer is associated with brain atrophy in multiple sclerosis. Neurology 2007;69:1603-9.
• ) Pulicken M, Gordon-Lipkin E, Balcer LJ, Frohman E, Cutter G, Calabresi PA. Optical coherence tomography and disease subtype in multiple sclerosis. Neurology 2007;69:2085-92.
• ) Henderson AP, Trip SA, Schlottmann PG, Altmann DR, Garway-Heath DF, Plant GT,et al. An investigation of the retinal nerve fibre layer in progressive multiple sclerosis using optical coherence tomography. Brain 2008;131(Pt 1):277- 87.
• ) Pueyo V, Martin J, Fernandez J, Almercegui C, Ara J, Egea C, et al. Axonal loss in the retinal nerve fiber layer in patients with multiple sclerosis. Mult Scler 2008;14:609-14.
• ) Toledo J, Sepulcre J, Salinas-Alaman A, Garcia-Layana A, Murie-Fernandez M, Bejarano B, et al. Retinal nerve fiber layer atrophy is associated with physical and cognitive disability in multiple sclerosis. Mult Scler 2008;14:906-912.
• ) Laron M, Cheng H, Zhang B, Schiffmann JS, Tang RA, Frishman LJ. Comparison of multifocal visual evoked potential, standard automated perimetry and optical coherence tomography in assesing visual pathway in multiple sclerosis patients. Mult Scler 2010; 16: 412-26.