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The Inner Nuclear Layer in Pediatric Multiple Sclerosis
Hannah Hummel-Abmeier1,2, Sabine Naxer3, Ella Maria Kadas4,5
1Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Georg-August-Universität Göttingen, Germany.
Neurology(R) Neuroimmunology & Neuroinflammation
|March 26, 2025
Summary
In pediatric multiple sclerosis (MS), the inner nuclear layer (INL) thickens after optic neuritis (ON), unlike other retinal layers that thin. INL thickness did not correlate with disease severity in this study.
Area of Science:
- Ophthalmology
- Neuroscience
- Pediatric Neurology
Background:
- Pediatric onset multiple sclerosis (POMS) causes optic nerve and retinal damage, including thinning of the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell and inner plexiform layer (GCIP).
- The inner nuclear layer (INL) thickness is hypothesized to increase with inflammation or after acute optic neuritis (ON) and decrease with neurodegeneration.
- Macular microcysts in the INL have been observed in adult MS patients.
Purpose of the Study:
- To investigate the inner nuclear layer (INL) in a large cohort of pediatric onset multiple sclerosis (POMS) patients.
- To evaluate the INL as a potential biomarker for disease course and therapeutic success in POMS.
- To compare INL changes in POMS with and without a history of optic neuritis (ON) to healthy controls.
Main Methods:
- A cross-sectional case-control study involving 153 patients with POMS and 92 controls.
- Prospective recruitment of participants, including asymptomatic healthy volunteers and children with nonretinal disorders.
- Optical coherence tomography (OCT) with intraretinal segmentation and best-corrected visual acuity (BCVA) assessment.
Main Results:
- Eyes with POMS and prior ON showed increased INL thickness (44.31 µm) compared to controls (42.96 µm, p=0.014).
- pRNFL (83 µm) and GCIP thickness (68.42 µm) were reduced in POMS eyes with prior ON compared to controls (pRNFL 97 µm, GCIP 78.53 µm).
- No significant differences in INL or other layer thicknesses were found in POMS eyes without ON history compared to controls. pRNFL and GCIP loss correlated with worse BCVA, but INL thickness did not.
Conclusions:
- The INL in POMS exhibits changes comparable to adult MS, though macular microcysts are considerably rarer.
- The absence of a cross-sectional association between INL thickness and disease severity suggests early-stage disease where neuroinflammation, rather than neurodegeneration, is predominant.
- Further longitudinal studies are needed to clarify the role of INL changes as a biomarker in POMS.
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