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Santiago Ortiz-Perez, Elena Martinez-Lapiscina, Iñigo Gabilondo, Elena Fraga-Pumar, Sara Llufriu, Albert Saiz, Bernardo Sanchez-Dalmau, Pablo Villoslada; Association between retinal impairment and disease severity in Multiple Sclerosis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2347.
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To study the association between retinal lesions, including retinal periphlebitis (RP) and microcystic macular edema (MME), and disease severity in multiple sclerosis (MS).
We studied a prospective cohort of 100 patients with MS. Neurological and ophthalmic examination as well as MRI and Optical Coherence Tomography (OCT) were done in all participants. We compared clinical features, MRI and OCT parameters among participants with and without retinopathy in our cohort. We used general lineal models to evaluate adjusted means of T1-MPRAGE total lesion volume, Retinal Never Fiber Layer (RNFL) thickness and EDSS (baseline and change after 1 year follow-up) among patients with and without RP.
7 out of 100 MS patients had retinopathy, 5 had RP (5%) and 2 had MME (2%). We only identified 2 cases of MME; therefore our study was underpowered to assess the association between MME and clinic-radiological MS severity. Clinically, patients with RP had a non-significantly higher adjusted-mean of EDSS score at baseline [adjusted differences: +0. 46 95% CI (-0.49 to +1.41);p=0. 341] and EDSS progression after 1 year of follow up [adjusted differences: +0.32 95%CI(-0.03 to +0.66),p=0.072] compared to patients without retinopathy. These patients had also a significantly higher adjusted-mean of T1-MPRAGE lesion volume [adjusted differences: +10453 95%CI(+549 to +20357);p=0.039] and lower mean of RNFL thickness at baseline [adjusted differences: +13.4 95%CI(-24.4 to -2.3); p=0. 018]
Full ophthalmic assessment is mandatory in MS patients in order to study the visual pathway impairment and its possible relation with others impaired systems. Retinal lesions, especially RP is more frequent in MS patients with more severe disease suggesting that it can become a biomarker of disease severity. More studies are needed to establish the role of the different ophthalmic findings as possible biomarkers in MS.
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