Detection of clinical and subclinical retinal abnormalities in neurosarcoidosis with optical coherence tomography.
The aim of this work was to determine if neurosarcoidosis (NS) patients exhibit quantitative and/or qualitative in vivo evidence of retinal abnormalities on optical coherence tomography (OCT). Retinal imaging was performed using spectral-domain Cirrus HD-OCT in 20 NS patients (40 eyes) and 24 age-matched healthy controls (48 eyes). Study participants also underwent magnetic resonance imaging of the brain and spine, cerebrospinal fluid (CSF) analysis, and detailed neurological and ophthalmological evaluation. Quantitative OCT abnormalities of average macular thickness (AMT), peri-papillary retinal nerve fiber layer (RNFL) thickness, or both, were detectable in 60% of NS patients. Of NS patients with ocular symptomatology, 75% demonstrated quantitative OCT abnormalities, while only 25% had detectable abnormalities on detailed ophthalmological assessment. Furthermore, 33% of NS patients without ocular symptoms had quantitative OCT changes, while only 8% had abnormal ophthalmologic examination. RNFL and macular thinning and swelling were significant in the NS cohort compared to healthy controls (variance ratio testing; RNFL: p = 0.02, AMT: p = 0.006). AMT also correlated inversely with disease duration (r (s) = -0.65, p = 0.002). Patient proportions with OCT abnormalities did not differ according to NS subtype (myelopathic, meningeal, or encephalitic NS), CSF findings, or immunotherapy exposure. No qualitative OCT abnormalities were detected. Retinal abnormalities occur in all NS subtypes, and may be clinical or subclinical. Our findings suggest OCT may enable greater detection of retinal abnormalities in NS than ophthalmological assessment alone, and have implications for the assessment of ocular involvement in NS, and sarcoidosis in general. Longitudinal NS studies utilizing OCT are warranted.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ceckstein@usouthal.edu
Christopher
C
Eckstein
Shiv
S
Saidha
Elias S
ES
Sotirchos
Gita
G
Byraiah
Michaela
M
Seigo
Aleksandra
A
Stankiewicz
Stephanie B
SB
Syc
E'tona
E
Ford
Srilakshmi
S
Sharma
Peter A
PA
Calabresi
Carlos A
CA
Pardo
D000328:Adult; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000150:complications; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis* / Q000209:etiology*; D012507:Sarcoidosis / Q000150:complications; D013118:Spinal Cord Diseases / Q000150:complications / Q000473:pathology; D018709:Statistics, Nonparametric; D041623:Tomography, Optical Coherence / Q000379:methods*