Retinal venous sheathing and the blood-retinal barrier in multiple sclerosis.
OBJECTIVE
To assess the temporal relations among retinal appearance, disruption of the blood-retinal barrier, clinical subgroup, disease course, and disruption of the blood-brain barrier in multiple sclerosis.


METHODS
A 6-month prospective study involving monthly clinical ocular examinations, color fundus photography, fundus fluorescein angiograms, and magnetic resonance brain scans with gadolinium-diethylenetriamine-pentaacetic acid (Gd-DPTA) enhancement.


METHODS
University-based ophthalmology and neurology departments.


METHODS
Twenty-three patients with relapsing-remitting, primary-progressive, or secondary-progressive multiple sclerosis.


RESULTS
Retinal venous sheathing was seen in six patients. The appearances observed included focal venous sheathing, diffuse venous sheathing, sheathing centered on sites of arteriovenous crossover, and focal perivenous hemorrhage. Arteriolar sheathing was also observed in one patient. Venous leakage on fundus fluorescein angiogram was detected in three patients, all of whom also had sheathing. The following three patterns of disruption of the blood-retinal barrier were seen on fundus fluorescein angiogram: focal leakage, extensive leakage, and very late wall staining. In one patient, the leakage was transitory. No correlations were observed between ophthalmologic features and multiple sclerosis clinical subgroup, disease course, or the number of new (Gd-DTPA-enhancing) lesions on magnetic resonance imaging.


CONCLUSIONS
Disruption of the blood-retinal barrier, like the more frequent disruption of the blood-brain barrier seen on magnetic resonance imaging, is often unrelated to clinical neurologic relapses and occurs with apparently similar frequency in different patients independent of clinical disease course.
St Paul's Eye Unit, Royal Liverpool England University Hospital.
M K
MK
Birch
S
S
Barbosa
L D
LD
Blumhardt
C
C
O'Brien
S P
SP
Harding
D000328:Adult; D001813:Blood-Retinal Barrier; D001921:Brain / Q000473:pathology; D002199:Capillary Permeability; D003287:Contrast Media; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D010689:Phlebitis / Q000209:etiology / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D012164:Retinal Diseases / Q000209:etiology / Q000473:pathology; D012169:Retinal Vein / Q000473:pathology*
D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA