Objective:We used ultra-high resolution spectral domain optical coherence tomography (UHR-OCT) to analyze the subclinical changes in retinal neurons,axon injury,and retinal thickness in neuromyelitis optica spectrum disorders (NMOSD) patients.Methods:This case-control study included 21 cases of NMOSD patients and 20 matched healthy volunteers (control group).The NMOSD patients were divided into a subgroup without optic neuritis (NO-ON) (13 eyes) and a subgroup with optic neuritis (ON) group (13 eyes).The thickness of the total retina of each patient and control subject was evaluated by using UHR-OCT.Data of each layer were analyzed using one-way ANOVA.Results:Except at the central region,the total retinal thickness of the ON group in whole mapping images was significantly thinner than the control group and NO-ON group.There were significant differences in total thickness between the NO-ON group and the control group in some regions (nasal interior [NI],P=0.011;temporal interior[TI],P=0.003;superior exterior [SE],P=0.019;inferior exterior [IE],P=0.002).The thicknesses of the retinal nerve fiber layer (RNFL) and the combined ganglion cell layer and inner plexiform layer (GCL+IPL) in the ON group was significantly thinner in each quadrant compared with the control group (P＜ 0.001).The RNFL thickness of the NO-ON group was thinner in the nasal and temporal areas compared with the control group (NI,P=0.049;TI and temporal exterior [TE],P＜ 0.001).The GCL+IPL thickness in the NO-ON group was thinner than control group (SE,P＜ 0.001;IE,P=0.002).The thickness of inner nuclear layer (INL) in the ON group was thicker than in the control group (superior interior [SI],P=0.001;inferior interior [II],P=0.003;TE,P=0.043);however the thickness of the INL in the NO-ON group was thinner than in the control group (SE,P=0.015;IE,P=0.012).The thickness of Henle fiber layer and outer nuclear layer (HFL+ONL) in the NO-ON group was thinner than for the control group (SI,P=0.009;SE,P=0.018;Ⅱ,P=0.001;IE,P=0.001),but there were no significant differences between the ON group and the control group.Conclusions:There were significant changes in the different retinal layers of NMOSD patients compared to healthy controls.The thicknesses of RNFL and GCIPL in the NO-ON subgroup were decreased,suggesting that NMOSD patients with no optic neuritis potentially have structural damage in the retinal nerve.%目的:分析视神经脊髓炎谱系疾病(NMOSD)在超高分辨谱域光学相干断层成像(UHR-OCT)中视网膜神经纤维和轴突损伤、视网膜厚度的亚临床变化,以更好地监测疾病进展和治疗该疾病.方法:病例对照研究.利用UHR-OCT分析21例NMOSD患者和20例健康志愿者(健康对照组)的9个区域视网膜结构厚度,并根据NMOSD患者是否伴有视神经炎又分为非视神经炎(NO-ON)组(13眼)和视神经炎(ON)组(13眼).运用单因素方差分析比较各组之间视网膜厚度的差异.结果:ON组在总厚度上较健康对照组、NO-ON组薄,除中央区外,其余区域差异均有统计学意义(均P＜0.001).NO-ON组视网膜总厚度较健康对照组视网膜薄,主要在鼻侧内环(P=0.011)、颞侧内环(P=0.003)以及上侧外环(P=0.019)、下侧外环(P=0.002),差异均有统计学意义.ON组视网膜神经纤维层(RNFL)及神经节细胞层+内丛状层(GCL+IPL)厚度在各象限与健康对照组相比较薄(P＜0.001),NO-ON组的RNFL厚度较健康对照组鼻侧内环(P=0.049)和颞侧(P＜0.001)薄.NO-ON组的GCL+IPL较健康对照组上侧外环(P＜0.001)和下侧外环(P=0.002)薄.ON组内核层厚度较对照组上侧内环(P=0.001)、下侧内环(P=0.003)、颞侧外环(P=0.043)厚,而NO-ON组较对照组在上侧外环(P=0.015)、下侧外环(P=0.012)薄.NO-ON组的Henle纤维层+外核层厚度较对照组比较在上侧内环(P=0.009)、上侧外环(P=0.018)、下侧内环(P=0.001)、下侧外环(P=0.001)有下降,ON组与对照组比较差异无统计学意义.结论:本研究发现NMOSD患者不同层次的视网膜结构存在改变,在视神经未受累眼视网膜RNFL和GCIPL存在厚度下降,提示NMOSD患者未受累眼存在潜在的视网膜神经结构损伤.
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