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Retinal pathology in idiopathic moyamoya angiopathy detected by optical coherence tomography
Philipp Albrecht1, Christine Blasberg2, Sebastian Lukas2
1From the Departments of Neurology (P.A., C.B., M.R., A.-K.M., J.H., O.A., H.-P.H.) and Ophthalmology (D.F., R.G.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Neurology Clinic (S.L.), Department of Clinical Neuroimmunology and Multiple Sclerosis Research, University Medical Center Zürich, Switzerland; Charité-Universitätsmedizin Berlin (E.-M.K., F.P., A.U.B.), NeuroCure Clinical Research Center and Department of Neurology, Berlin; Department of Neurology (A.M.), University Medical Center, Johannes Gutenberg University Mainz; and Department of Neurology (P.B., M.K.), Alfried Krupp Hospital, Essen, Germany. phil.albrecht@gmail.com.
Objective:
To investigate whether patients with moyamoya angiopathy without obvious retinal pathologies such as retinal infarctions or the congenital morning glory anomaly may have subtle subclinical retinal changes.
Methods:
In this cross-sectional study, spectral domain optical coherence tomography was used to analyze the retinal morphology of 25 patients with idiopathic moyamoya angiopathy and 25 age- and sex-matched healthy controls. We analyzed the retinal vasculature with blue laser autofluorescence, lipofuscin deposits with MultiColor confocal scanning laser ophthalmoscopy, and the optic nerve head (ONH) volume with a custom postprocessing algorithm. In addition to the total retinal thickness, semiautomated segmentation was used for segmentation of retinal layers in macular cross scans, macular volume scans, and peripapillary ring scans.
Results:
The main finding was a pronounced reduction of the ONH volume in moyamoya angiopathy compared with controls (0.76 ± 0.45 mm(3) and 1.47 ± 0.50 mm(3), respectively; p < 0.0001), which was associated with a less pronounced reduction of the retinal nerve fiber layer in macular volume scans (0.97 ± 0.11 mm(3) and 1.10 ± 0.10 mm(3), respectively; p < 0.001). Autofluorescence and MultiColor confocal scanning laser ophthalmoscopy images revealed no pathologies except for one branch retinal artery occlusion.
Conclusion:
Our results indicate that even patients with moyamoya angiopathy who do not have obvious retinal abnormalities have retinal abnormalities. These can be detected by spectral domain optical coherence tomography, and the association of ONH abnormalities with the vascular changes may suggest that idiopathic moyamoya angiography is a systemic disease involving abnormalities of the early mesodermal development.
