Retinal Microstructural Changes Reflecting Treatment-Associated Cognitive Dysfunction in Patients with Lower-Grade Gliomas

IF 3.2 Q1 OPHTHALMOLOGY
Arina Nisanova BA , Ashutosh Parajuli BS , Bhavna Antony PhD , Orwa Aboud MD, PhD , Jinger Sun MD, PhD , Megan E. Daly MD , Ruben C. Fragoso MD, PhD , Glenn Yiu MD, PhD , Yin Allison Liu MD, PhD
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引用次数: 0

Abstract

Purpose

To determine whether microstructural retinal changes, tumor features, and apolipoprotein E (APOE) ε4 polymorphism are correlated with clinically detectable treatment-associated cognitive dysfunction (TACD) in patients with lower-grade gliomas.

Design

Cohort study.

Participants and Controls

Sixteen patients with lower-grade glioma at a United States academic ophthalmology department between January 2021 and November 2023. Normal controls were recruited from convenient sampling.

Methods

Montreal Cognitive Assessment (MoCA) scores and retinal changes were assessed in 6-month intervals. Apolipoprotein E genotyping was performed, and tumor details were recorded. Partial least-squares discriminant (PLSD) model was established to evaluate the association between TACD with APOE genotype, ophthalmic, and tumor features.

Main Outcome Measures

The main outcome measure was cognitive status as measured by the MoCA score and analyzed in relation to ophthalmic measurements, tumor features, and APOE genotype.

Results

Median time to first eye examination was 34 months (2–266) from tumor diagnosis and 23 months (0–246) from radiation. Nine patients (56%) had abnormal cognition (MoCA <26/30). Montreal Cognitive Assessment scores were significantly worse in patients with temporal (22 ± 7.2) than frontal lobe tumors (26 ± 3.1, P = 0.02) and those with oligodendrogliomas (22 ± 4.1) than astrocytomas (26 ± 3.6, = 0.02). Patients with TACD had significant radial peripapillary capillary density loss (45% ± 4.6) compared with those with normal cognition (49% ± 2.6, P = 0.02). A PLSD model correlated MoCA scores with retinal nerve fiber thickness, intraocular pressure, foveal avascular zone, best-corrected visual acuity, months since first diagnosis, and tumor pathology (oligodendroglioma or not). Using these features, the model identified patients with TACD with 77% accuracy. Apolipoprotein E genotyping showed: 2 ε2/ε3 (13%), 10 ε3/ε3 (63%), and 1 ε3/ε4 (6%).

Conclusions

Retinal microstructural changes may serve as biomarkers for TACD in patients with lower-grade gliomas. Temporal lobe tumors and oligodendrogliomas may increase susceptibility to TACD. Utilization of retinal markers may enhance TACD diagnosis, progression monitoring, and inform management of lower-grade patients with glioma. A larger study with serial eye examinations is warranted to evaluate the role of APOE ε4 and develop a predictive model.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

反映低级别胶质瘤患者治疗相关认知功能障碍的视网膜微结构变化
目的确定视网膜微结构变化、肿瘤特征和载脂蛋白E(APOE)ε4多态性是否与低级别胶质瘤患者临床上可检测到的治疗相关认知功能障碍(TACD)相关。方法每隔 6 个月评估蒙特利尔认知评估(MoCA)评分和视网膜变化。进行载脂蛋白 E 基因分型,并记录肿瘤细节。建立部分最小二乘判别(PLSD)模型,评估TACD与APOE基因型、眼科和肿瘤特征之间的关联。结果首次眼科检查的平均时间为肿瘤诊断后34个月(2-266),放射治疗后23个月(0-246)。九名患者(56%)认知异常(MoCA 26/30)。颞叶肿瘤患者的蒙特利尔认知评估评分(22 ± 7.2)明显低于额叶肿瘤患者(26 ± 3.1,P = 0.02),少突胶质细胞瘤患者的蒙特利尔认知评估评分(22 ± 4.1)明显低于星形细胞瘤患者(26 ± 3.6,= 0.02)。与认知功能正常的患者(49% ± 2.6,P = 0.02)相比,TACD 患者的径向毛细血管周围密度明显下降(45% ± 4.6)。PLSD模型将MoCA评分与视网膜神经纤维厚度、眼压、眼窝血管区、最佳矫正视力、首次诊断后的月数、肿瘤病理(是否少突胶质细胞瘤)相关联。利用这些特征,该模型识别TACD患者的准确率为77%。载脂蛋白 E 基因分型显示结论视网膜微结构变化可作为低级别胶质瘤患者 TACD 的生物标志物。颞叶肿瘤和少突胶质细胞瘤可能会增加TACD的易感性。利用视网膜标记物可加强TACD诊断和病情进展监测,并为低级别胶质瘤患者的管理提供信息。有必要进行更大规模的连续眼部检查研究,以评估APOE ε4的作用并建立预测模型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ophthalmology science
Ophthalmology science Ophthalmology
CiteScore
3.40
自引率
0.00%
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审稿时长
89 days
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