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Retinal Changes in Double-Antibody Seronegative Neuromyelitis Optica Spectrum Disorders
Frederike C Oertel1, Hanna G Zimmermann1, Seyedamirhosein Motamedi1
1From the Experimental and Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin; Neuroscience Clinical Research Center (F.C.O., H.G.Z., S.M., C.B., L.M.M., A.U.B., F.P.); Department of Neurology (F.C.O., F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Einstein Center Digital Future (H.G.Z.), Berlin, Germany; Kashani MS Center (F.A.), Isfahan University of Medical Sciences; School of Advanced Technologies in Medicine and Medical Image and Signal Processing Research Center (R.K.); Department of Ophthalmology (A.D., M. Pourazizi), Isfahan Eye Research Center, Isfahan University of Medical Sciences, Iran; Department of Neurology (L.P., A.D.C.), KS Hegde Medical Academy, Nitte University, Mangalore, India; Department of Neurology (O.A., P.A., M. Ringelstein), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurlogy (P.A.), Kliniken Maria Hilf Mönchengladbach; Centre for Neurology and Neuropsychiatry (M. Ringelstein), Landschaftsverband Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Hospital Clinic of Barcelona-Institut d'Investigacions (E.H.M.-L., B.F.S.D., P.V.), Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain; Departments of Neurology (N.A.), Slagelse Hospitals, Denmark, Institute of Regional Health Research; Institute of Molecular Medicine (N.A.), University of Southern Denmark, Odense, Denmark; Service de Neurologie (R.M., A.C.-C.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Spain; Experimental Neurophysiology Unit (L.L., M. Pisa, M. Radaelli), Institute of Experimental Neurology (INSPE) Scientific Institute San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Department of Neurology (J.P., A.R.-F., M.I.S.L.); Department of Ophthalmology (S.S.), Oxford University Hospitals, National Health Service Trust, United Kingdom; Neurology Service (J.D.S., T.S.), University Hospital of Strasbourg, France; Department of Medicine (M.R.Y.), Divisions of Molecular Medicine and Infectious Diseases, Harbor-University of California at Los Angeles (UCLA) Medical Center, and Lundquist Institute for Biomedical Innovation, Torrance; Department of Medicine (M.R.Y.), David Geffen School of Medicine at UCLA, Los Angeles; Departments of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center; Division of Metabolism (T.J.S.), Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; and Department of Pediatrics (L.J.C.), University of Utah.
Double-antibody seronegative neuromyelitis optica spectrum disorder (DN-NMOSD) causes significant retinal damage, even before optic neuritis. Early diagnosis and treatment are crucial due to rapid neuroaxonal loss.
Area of Science:
- Neuroscience
- Ophthalmology
- Immunology
Background:
- Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune diseases affecting the central nervous system.
- Double-antibody seronegative NMOSD (DN-NMOSD) lacks specific antibodies, making diagnosis challenging.
- Retinal involvement is a key feature of NMOSD, but its extent in DN-NMOSD is not fully understood.
Purpose of the Study:
- To systematically describe the clinical presentation of DN-NMOSD, focusing on retinal changes.
- To compare retinal neurodegeneration in DN-NMOSD with aquaporin-4 antibody seropositive NMOSD (AQP4-NMOSD) and healthy controls (HCs).
Main Methods:
- Cross-sectional study including 25 DN-NMOSD patients, 25 AQP4-NMOSD patients, and 25 HCs, matched for age and sex.
- Optical coherence tomography (OCT) was used to measure peripapillary retinal nerve fiber layer thickness (pRNFL) and ganglion cell-inner plexiform layer thickness (GCIPL).
- Neurologic examination and antibody testing were performed.
Main Results:
- DN-NMOSD patients experienced a median of 6 attacks, with myelitis and optic neuritis (ON) being most common.
- Retinal neurodegeneration (thinner pRNFL and GCIPL) was observed in DN-NMOSD eyes after ON compared to HCs.
- Significant neuroaxonal loss was evident even after a single ON episode and also in DN-NMOSD eyes without a history of ON.
- No significant differences in retinal layer thickness were found between DN-NMOSD and AQP4-NMOSD groups.
Conclusions:
- DN-NMOSD is characterized by severe retinal damage, including attack-independent neurodegeneration.
- Most retinal damage occurs during the initial ON episode, emphasizing the need for early diagnosis and treatment.
- Homogeneous clinical and imaging findings suggest a common retinal pathology in DN-NMOSD.
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