目的:急性视神经炎(AON)后恢复视力对于改善脱髓鞘疾病患者的生活质量至关重要。该研究的目的是前瞻性评估视力的变化,视网膜层厚度,和AON患者的皮层视觉网络,以确定永久性视力障碍的预测因子。
方法:我们对88例AON患者进行了前瞻性队列研究,随访6个月,使用高对比和低对比(2.5%)视力,色觉,来自光学相干断层扫描的视网膜厚度,多焦点视觉诱发电位的潜伏期和振幅,视野平均偏差,和基于扩散的结构(n=53)和功能(n=19)的脑MRI来分析皮层视觉网络。主要结果是2.5%的低对比视力,数据采用混合效应和多元回归模型进行分析。
结果:我们发现6个月后,低对比度视力和视力质量仍然中度受损。基线时神经节细胞层的厚度是6个月后低对比度视力的预测因子(β=0.49[CI0.11-0.88],p=0.012)。基线时的结构性皮层视觉网络预测低对比度视觉,最佳预测因子是右侧海马旁皮质的介数(β=-036[CI-0.66至0.06],p=0.021),右侧V3的节点强度(β=1.72[CI0.29-3.15],p=0.02),和左顶内沟的聚类系数(β=57.8[CI12.3-103.4],p=0.015)。基线时的功能性皮层视觉网络也预测了低对比度视觉,最好的预测因子是左腹侧枕骨皮质的中间性(β=8.6[CI:4.03-13.3],p=0.009),右侧顶内沟的节点强度(β=-2.79[CI:-5.1-0.4],p=0.03),和左顶叶上小叶的聚类系数(β=501.5[CI50.8-952.2],p=0.03)。
结论:基线视觉通路评估预测AON后的永久性视力障碍,表明损伤是在疾病发作后早期产生的,它可用于定义视力障碍和指导治疗。
OBJECTIVE: Recovery of vision after acute optic neuritis (AON) is critical to improving the quality of life of people with demyelinating diseases. The objective of the study was to prospectively assess the changes in visual acuity, retinal layer thickness, and cortical visual network in patients with AON to identify the predictors of permanent visual disability.
METHODS: We studied a prospective cohort of 88 consecutive patients with AON with 6-month follow-up using high and low-contrast (2.5%) visual acuity, color vision, retinal thickness from optical coherence tomography, latencies and amplitudes of multifocal visual evoked potentials, mean deviation of visual fields, and diffusion-based structural (n = 53) and functional (n = 19) brain MRI to analyze the cortical visual network. The primary outcome was 2.5% low-contrast vision, and data were analyzed with mixed-effects and multivariate regression models.
RESULTS: We found that after 6 months, low-contrast vision and quality of vision remained moderately impaired. The thickness of the ganglion cell layer at baseline was a predictor of low-contrast vision 6 months later (ß = 0.49 [CI 0.11-0.88], p = 0.012). The structural cortical visual network at baseline predicted low-contrast vision, the best predictors being the betweenness of the right parahippocampal cortex (ß = -036 [CI -0.66 to 0.06], p = 0.021), the node strength of the right V3 (ß = 1.72 [CI 0.29-3.15], p = 0.02), and the clustering coefficient of the left intraparietal sulcus (ß = 57.8 [CI 12.3-103.4], p = 0.015). The functional cortical visual network at baseline also predicted low-contrast vision, the best predictors being the betweenness of the left ventral occipital cortex (ß = 8.6 [CI: 4.03-13.3], p = 0.009), the node strength of the right intraparietal sulcus (ß = -2.79 [CI: -5.1-0.4], p = 0.03), and the clustering coefficient of the left superior parietal lobule (ß = 501.5 [CI 50.8-952.2], p = 0.03).
CONCLUSIONS: The assessment of the visual pathway at baseline predicts permanent vision disability after AON, indicating that damage is produced early after disease onset and that it can be used for defining vision impairment and guiding therapy.