Author: Daniela Montorio (Italy)
Co-authors: Roberta Lanzillo, Vincenzo Brescia Morra, Gilda Cennamo
To investigate the vessel density (VD) in macular and papillary regions, by means of Optical Coherence Tomography Angiography (OCTA) over two-years after an initial demyelinating event (IDE) in multiple sclerosis (MS) patients to identify early biomarkers in diagnosis of this disease.
University of Naples “Federico II”, Naples, Italy
A total of thirty eyes from 15 IDE patients (7 females, 8 males, mean age 28.4 ± 9.6 years) was enrolled by Multiple Sclerosis Centre. They underwent a neurological evaluation and a subsequent complete ophthalmological assessment. The VD was analyzed, using OCTA, in superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) and radial peripapillary capillary plexus (RPC) at baseline and after one and two years of follow up. We also evaluated structural OCT parameters [ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL)] changes.
GCC and RNFL thicknesses did not change over time. After one year, compared with baseline we did not identify changes in OCTA and OCT measures. After 2 years, a reduced VD was found in SCP, DCP and RPC respect to baseline (coeff. β = -2.779, p= 0.013; coeff. β = -4.055, p= 0.018 and coeff. β = -2.687, p =0.001; respectively). These changes were confirmed when comparing measures obtained after 2 years with those observed 1 year after. Conversely, VD of the CC did not show significant differences from baseline at any time point. VD reduction was not associated with EDSS change, relapses occurrence and magnetic resonance imaging activity.
Our findings showed in IDE patients a progressively increasing blood flow rarefaction, that could reflect a cerebrovascular degenerative process during the follow up. Retinal vascular loss occurs in early stages of MS independently from clinical and radiological disease activity and it is not associated with retinal atrophy. OCTA could be considered as an early biomarker in IDE patients follow up, showing abnormalities before the appearance of subsequent neuroaxonal loss. OCTA could represent a novel and helpful early biomarker in order to better define the vascular involvement in MS pathogenesis and to monitor the MS progression.