Ganglion Cell Layer Thickness as a Biomarker for Amyotrophic Lateral Sclerosis Functional Outcome: An OCT study.

Divya Singh, Somya Singhal, Vikas Kanaujiya, Ankita Ranjan, Vinita Elizabeth Mani, Vimal Kumar Paliwal, Vaibhav Jain, Ankita Aishwarya, Rachna Agarwal
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引用次数: 0

Abstract

Aim: This study aims to evaluate various optical coherence tomography (OCT) parameters in patients diagnosed with amyotrophic lateral sclerosis (ALS).

Methods: Assessment of BCVA was done using Snellen charts, and subjective refraction was done to achieve a BCVA for distance and near. Measurement of intraocular pressure (IOP) was done with Goldman applanation tonometry. Stereoscopic fundus examination was performed using a 90D lens to assess the status of the optic nerve and retina, ruling out any ocular pathology. The patients were then subjected to OCT scanning to measure optic nerve head and macular parameters. Optical coherence tomography was performed using CIRRUS™ HD OCT (500-21822) (version 8.0.0.518) (Carl Zeiss Meditec, Dublin, CA, USA). The analyzed area was centered manually, and the absence of segmentation errors was confirmed for each scan.

Results: RE Avg RNFL and LE Avg RNFL showed weak correlations with ALSFRS, indicated by Pearson Correlation coefficients of 0.073 and -0.026, respectively. The p-values (0.637 and 0.86) suggested that these correlations were not statistically significant. RE Avg GCL and LE Avg GCL, on the other hand, exhibited moderate positive correlations with ALSFRS scores, with correlation coefficients of 0.337 (RE) and 0.389 (LE). These correlations were statistically significant, as indicated by p-values of 0.021 and 0.006, respectively, suggesting a substantial association between GCL thickness and ALS functional outcomes.

Discussion: All patients in our study were clinically diagnosed cases of ALS, as per the El Escorial criteria. Age group-wise analysis showed statistically significant thinning overall as well as quadrant-wise RNFL parameters in patients less than 50 years compared to age-matched controls, indicating that the pathological process occurring in larger motor neurons in ALS might also be happening in smaller sensory neurons of the retina, causing thinning, which was not due to age-related process. Although GCIPL thinning was occurring in our cases, though statistically not significant compared to control, the significant positive correlation observed between GCIPL and ALS functional outcome and between RNFL and GCIPL measurements highlighted the fact that though the axonal degeneration in retinal neurons might not be translating to the same extent in ganglion cells in ALS, the subtle thinning of GCIPL correlated strongly with functional disability in patients with ALS, implying better functional scores with higher values of GCIPL parameters.

Conclusion: In summary, GCL measurements in both eyes showed a notable relationship with ALSFRS, whereas RNFL did not appear to correlate significantly.

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神经节细胞层厚度作为肌萎缩侧索硬化功能结局的生物标志物:一项OCT研究。
目的:本研究旨在评价各种光学相干断层扫描(OCT)参数在肌萎缩性侧索硬化症(ALS)患者诊断中的价值。方法:采用Snellen图评估BCVA,并进行主观屈光检查,获得远近BCVA。眼压(IOP)用Goldman眼压计测量。使用90D晶状体进行立体眼底检查,评估视神经和视网膜的状态,排除任何眼部病理。然后对患者进行OCT扫描,测量视神经头和黄斑参数。使用CIRRUS™HD OCT(500-21822)(版本8.0.0.518)(Carl Zeiss Meditec, Dublin, CA, USA)进行光学相干断层扫描。人工对分析区域居中,并确认每次扫描都没有分割错误。结果:RE Avg RNFL和LE Avg RNFL与ALSFRS呈弱相关,Pearson相关系数分别为0.073和-0.026。p值(0.637和0.86)表明这些相关性无统计学意义。RE平均GCL和LE平均GCL与ALSFRS评分呈中等正相关,相关系数分别为0.337 (RE)和0.389 (LE)。这些相关性具有统计学意义,p值分别为0.021和0.006,表明GCL厚度与ALS功能结局之间存在实质性关联。讨论:根据El Escorial标准,本研究中所有患者均为临床诊断的ALS病例。年龄组分析显示,与年龄匹配的对照组相比,年龄小于50岁的患者总体变薄以及象限方向的RNFL参数具有统计学意义,这表明ALS患者较大运动神经元中发生的病理过程可能也发生在较小的视网膜感觉神经元中,导致变薄,而这不是由于年龄相关的过程。虽然GCIPL变薄发生在我们的病例中,虽然与对照组相比统计上不显著,但GCIPL与ALS功能结果之间以及RNFL和GCIPL测量之间观察到的显著正相关突出了这样一个事实,即尽管视网膜神经元的轴突变性在ALS神经节细胞中可能没有达到相同的程度,但GCIPL的细微变薄与ALS患者的功能残疾密切相关。GCIPL参数越高,功能得分越高。结论:总之,双眼GCL测量与ALSFRS有显著的关系,而RNFL似乎没有显著的相关性。
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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