Detection of clinical and subclinical retinal abnormalities in neurosarcoidosis with optical coherence tomography

Christopher Eckstein, Shiv Saidha, Elias S. Sotirchos, Gita Byraiah, Michaela Seigo, Aleksandra Stankiewicz, Stephanie B. Syc, E'Tona Ford, Srilakshmi Sharma, Peter A. Calabresi, Carlos A. Pardo

Research output: Contribution to journalArticle

Abstract

The aim of this work was to determine if neurosarcoidosis (NS) patients exhibit quantitative and/or qualitative in vivo evidence of retinal abnormalities on optical coherence tomography (OCT). Retinal imaging was performed using spectral-domain Cirrus HD-OCT in 20 NS patients (40 eyes) and 24 age-matched healthy controls (48 eyes). Study participants also underwent magnetic resonance imaging of the brain and spine, cerebrospinal fluid (CSF) analysis, and detailed neurological and ophthalmological evaluation. Quantitative OCT abnormalities of average macular thickness (AMT), peri-papillary retinal nerve fiber layer (RNFL) thickness, or both, were detectable in 60% of NS patients. Of NS patients with ocular symptomatology, 75% demonstrated quantitative OCT abnormalities, while only 25% had detectable abnormalities on detailed ophthalmological assessment. Furthermore, 33% of NS patients without ocular symptoms had quantitative OCT changes, while only 8% had abnormal ophthalmologic examination. RNFL and macular thinning and swelling were significant in the NS cohort compared to healthy controls (variance ratio testing; RNFL: p = 0.02, AMT: p = 0.006). AMT also correlated inversely with disease duration (rs = -0.65, p = 0.002). Patient proportions with OCT abnormalities did not differ according to NS subtype (myelopathic, meningeal, or encephalitic NS), CSF findings, or immunotherapy exposure. No qualitative OCT abnormalities were detected. Retinal abnormalities occur in all NS subtypes, and may be clinical or subclinical. Our findings suggest OCT may enable greater detection of retinal abnormalities in NS than ophthalmological assessment alone, and have implications for the assessment of ocular involvement in NS, and sarcoidosis in general. Longitudinal NS studies utilizing OCT are warranted.

Original languageEnglish (US)
Pages (from-to)1390-1398
Number of pages9
JournalJournal of neurology
Volume259
Issue number7
DOIs
StatePublished - Jul 1 2012

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Keywords

  • Neurosarcoidosis
  • Optic neuropathy
  • Optical coherence tomography
  • Retina
  • Uveitis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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