Quantitative Study Of Microcirculation And Structure Of Optic Disc And Macular Area In Patients With Demyelinating Optic Neuritis

Part Ⅰ Quantitative study of microcirculation and structure of optic disc and macular area in patients with demyelinating optic neuritisObjective:To observe the changes of vessel density and retinal thickness in optic disc and macular in demyelinating optic neuritis(DON)patients,in order to provide theoretical basis for early diagnosis and differential diagnosis of clinical DON.Methods:In this study,a total of 32 patients with DON diagnosed for the first time and whose course of disease was less than 3 months were collected in the ophthalmology department of North Jiangsu People’s Hospital from December 2021 to December 2022.They were divided into the affected eye group and the unaffected contralateral eye group.There were 32 cases in the affected eye group and 20 cases in the unaffected contralateral eye.At the same time,38 healthy volunteers with the same gender and age as DON patients were selected as the normal control group.The demographic data and clinical characteristics of patients were collected.All subjects underwent routine ophthalmic examination and OCTA examination.OCTA examination includes scanning the 4.5mm×4.5mm region of optic disc and the whole and each partition of the 6mm×6mm region of macular region,obtaining the corresponding OCTA image and quantifying the data.Collected into the set of objects all region of vascular and capillary vessel density,the macular area superficial capillary plexuses(SCP),deep capillary plexuses(DCP)blood flow density.At the same time,the retinal nerve fiber layer(RNFL)thickness around the optic disc,ganglion cell layer complex thickness(GCC)of the macula,focal loss of volume(FLV),general loss of volume(GLV)was collected.the area and circumference of the foveal avascular zone(FAZ)were also collected.The differences of optic disc,macular microcirculation and retinal structural indexes in the affected eye group of DON patients,the uninvolved contralateral eye group of DON patients and the normal healthy control group were analyzed and compared.Paired sample T test or Wilcoxon sign rank sum test were used to compare blood flow density and structural parameters between the affected and unaffected contralateral eyes.Independent sample T-test or Mann-Whitney U test was used to compare blood flow density and structural parameters between the affected eye group and the healthy control group and the unaffected contralateral eye group and the healthy control group.Results:(1)Compared with the unaffected contralateral eye group and the healthy control group,the density of all vessels and capillaries in all sectors around the optic disc in the affected eye group of DON patients was significantly decreased except for the nasal sector(P<0.05).There was no significant difference in the whole area,inside and around the optic disc of the affected eye compared with the contralateral eye in DON patients(P>0.05).The overall capillary blood flow density around the optic disc of DON patients was significantly decreased compared with the healthy control group(P<0.05).The density of capillary and all vessels in the unaffected contralateral eye group was significantly lower than that in healthy control group(P<0.05).(2)Compared with the unaffected contralateral eye group,the density of SCP in the parafoveal and perifoveal area,but no significant difference was found in the SCP in the nasal and temporal regions of parafovea and the temporal regions around fovea(P>0.05).Compared with the healthy control group,the SCP density in the macular area of DON patients was decreased in the whole area,parafovea and all the regions around the fovea,but there was no significant difference in the whole area and its upper half area,parafovea temporal area and its upper area(P>0.05).Compared with healthy control group,there were no significant changes in SCP zones of contralateral eye(P>0.05).The density of DCP in the macular area of DON patients showed no significant difference in each area and the whole area compared with the contralateral eye,except for the upper part of the parafovea.Except for the temporal zone around fovea,there was no significant difference in all zones and the whole group compared with the healthy control group..(3)Compared with the healthy control group and unaffected contralateral eye group,the thickness of RNFL in each zone of the affected eye of DON patients were thickened(P>0.05).There was no significant difference in RNFL thickness between unaffected contralateral eye group and healthy control group(P>0.05).(4)Compared with the unaffected contralateral eye group and the healthy eye group,the thickness of each zone in the affected eye of DON patients were thinner,and FLV and GLV were significantly increased(P<0.05).There were no significant differences in GCC thickness,FLV and GLV between contralateral eye and healthy control group(P>0.05).(5)The area and circumference of FAZ in the affected eye and the unaffected contralateral eye of DON patients decreased significantly compared with the healthy control group,but no significant difference was found in the area and circumference of FAZ between the affected eye and the contralateral eye.Conclusion:(1)The vascular density in part of optic disc of DON patients with disease course ≤3 months was lower than that in contralateral eye and healthy control group.(2)The density of SCP vessels in the macular fovea of DON affected eye was lower than that in contralateral eye and healthy control group.(3)Compared with the contralateral eye and the healthy control group,the RNFL of the affected eye of DON was significantly thickened,and the thickness of GCC,FLV and GLV were significantly increased.(4)The area and circumference of FAZ in DON patients and unaffected contralateral eyes were significantly reduced compared with contralateral eyes,and there was no significant difference between affected and contralateral eyes.Part Ⅱ Preliminary study on the microcirculation and structure of optic disc and macular area in patients with different subtypes of demyelinating optic neuritisObjective:Using the optical coherence tomography angiography(OCTA)obtain aquaporin-4 antibody(AQP4-IgG)positive for optic neuritis(AQP4-ON)and myelin oligodendrocyte glycoprotein antibody(MOG-IgG)positive patients with optic neuritis(MOG-ON)and serum antibody negative demyelinating optic neuritis(DON),the changes of blood perfusion and retinal structure in patients with DON provide theoretical support for diagnosis and differential diagnosis of demyelinating optic neuritis in clinic.Methods:This study was a cross-sectional study.A total of 32 patients with DON whose disease course ≤3 months were diagnosed in the ophthalmology department of North Jiangsu People’s Hospital from December 2021 to December 2022 were included in the study.There were 8 patients in the AQP4-IgG positive DON group(8 eyes),9 patients in the MOG-IgG positive DON group(13 eyes),and 15 patients in the serum antibody negative DON group(15 eyes).The demographic data and clinical characteristics of patients were collected.All subjects underwent routine ophthalmic examination and OCTA examination.Routine ophthalmic examination included Best corrected Visual Acuity(BCVA),intraocular pressure,fundus examination,OCTA examination includes scanning the 4.5mm × 4.5mm region of optic disc and the whole and each partition of the 6mm×6mm region of macular region,obtaining the corresponding OCTA image and quantifying the data.Collected into the set of objects all region of vascular and capillary vessel density,the macular area superficial capillary plexuses(SCP)、deep capillary plexuses(DCP)vessel density.At the same time,the retinal nerve fiber layer(RNFL)thickness around the optic disc,ganglion cell layer complex thickness(GCC)of the macula,focal loss of volume(FLV),general loss of volume(GLV)was collected.The area and circumference of the foveal avascular zone(FAZ)were also collected.The differences of microcirculation and structural indexes among the three groups were analyzed and compared.Vessel density and structural parameters were compared among the three groups using independent sample T test or Mann-Whitney U test.Results:(1)Compared with the MOG-ON group,there were no significant differences in vessel density of capillaries and all vessels in the whole area of optic disc,in and around the optic disc between the two groups.Compared with AQP4-ON group,the vessel density of capillaries and all vessels in the whole area of optic disc and the surrounding zones was lower in serum antibody negative group,and the difference was statistically significant(P<0.05),while there was no significant difference in the capillary density and total vascular density in optic disc between the two groups(P>0.05).Compared with MOG-ON group,AQP4ON group had a higher density of capillaries and all vessels in the whole area of optic disc,in and around optic disc,but only in the lower half,upper and lower regions around optic disc,the difference was statistically significant(P>0.05).(2)Compared with the antibody negative group,there were no significant differences in the SCP and DCP of the macular region as a whole,parafovea,perifovea and each area in the MOG-ON group(P>0.05).There was no significant difference in SCP density between AQP4-ON group and antibody-negative group(P>0.05),while DCP density in macular region of AQP4-ON group was significantly higher than that in antibody-negative group except for the whole lower half of the region,the lower half of the region around the fovea,the nasal and the lower part of the region(P<0.05).There was no significant difference in the density of macular SCP and DCP between the MOG-ON group and AQP4-ON group.(3)Compared with the antibody negative group,the mean RNFL thickness and RNFL thickness in each zone in the MOG-ON group were thickened,but only in the mean RNFL thickness and RNFL thickness in the lower half of the zone had statistical differences(P<0.05).The RNFL in the temporal zone of AQP4-ON group was thinner than that in the antibody-negative group,and the difference was statistically significant.Compared with AQP4-ON group,RNFL of AQP4-ON group was significantly thinner in the temporal region(P<0.05).(4)There were no significant differences in the thickness of GCC,FLV and GLV among the three groups(P>0.05).(5)There were no significant differences in the circumference and area of FAZ among the three groups(P>0.05).Conclusion:(1)The vessel density in optic disc area and part of DCP in macular area in serum antibody negative group was lower than that in AQP4-ON group.(2)The thickness of RNFL in the temporal division of serum antibody negative group was thinner than that in AQP4-ON group,and the thickness of RNFL in the mean and lower half of RNFL division was thinner than that in MOG-ON group.(3)The vessel density in some areas of the optic disc in MOG-ON group was lower than that in AQP4-ON patients,and the thickness of RNFL in the temporal area was greater than that in AQP4-ON patients.(4)There were no significant differences in the thickness of GCC,the circumference and area of FLV,GLV and FAZ among the three groups.