Linking the Presence of Macular Oedema to Structural and Functional Alterations in Retinitis Pigmentosa

Anna Friesacher; Lisette T. Lopez Torres; Christophe Valmaggia; Reinhard Rüesch; Margarita G. Todorova

doi:10.1055/a-1389-5416

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2021; 238(04): 418-427
DOI: 10.1055/a-1389-5416

Klinische Studie

Linking the Presence of Macular Oedema to Structural and Functional Alterations in Retinitis Pigmentosa

Verbindung zwischen Makulaödem und strukturellen und funktionellen Veränderungen bei Retinitis pigmentosa

Authors

Anna Friesacher

¹Department of Ophthalmology (Chairman Prof. Dr. med. Ch. Valmaggia), Cantonal Hospital St. Gallen, St. Gallen, Switzerland

²Department of Ophthalmology (Chairman Prof. Dr. med. H. Scholl), University of Basel, Basel, Switzerland
Lisette T. Lopez Torres

²Department of Ophthalmology (Chairman Prof. Dr. med. H. Scholl), University of Basel, Basel, Switzerland
Christophe Valmaggia

¹Department of Ophthalmology (Chairman Prof. Dr. med. Ch. Valmaggia), Cantonal Hospital St. Gallen, St. Gallen, Switzerland

²Department of Ophthalmology (Chairman Prof. Dr. med. H. Scholl), University of Basel, Basel, Switzerland
Reinhard Rüesch

¹Department of Ophthalmology (Chairman Prof. Dr. med. Ch. Valmaggia), Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Margarita G. Todorova

¹Department of Ophthalmology (Chairman Prof. Dr. med. Ch. Valmaggia), Cantonal Hospital St. Gallen, St. Gallen, Switzerland

²Department of Ophthalmology (Chairman Prof. Dr. med. H. Scholl), University of Basel, Basel, Switzerland

Abstract

Objective To investigate the association between the central retinal thickness (CRT), the retinal nerve fibre layer thickness (RNFL), and the functional alterations in retinitis pigmentosa (RP) patients.

Methods Forty-three patients with typical RP and nineteen age-matched controls, who underwent SD-OCT (macular and optic disc OCT protocols) and electrophysiology, were included. The RP group was divided into two subgroups: with clinical appearance of macular oedema (ME-RP; 30 eyes) and without macular oedema (no-ME; 44 eyes). Central retinal thickness OCT data were averaged in three zones (zone 1 [0°–3°], zone 2 [3°–8°], and zone 3 [8°–15°]) and were evaluated in relation to the RNFL thickness and electrophysiological data.

Results The ME-RP group showed increased CRT (zone 1) and RNFL thickness compared to the controls and no-ME-RP (p ≤ 0.002). The no-ME-RP group had reduced CRT thickness (all zones; p ≤ 0.018) compared to the controls and ME-RP, whereas the RNFL thickness in the no-ME-RP group was reduced only compared to the ME-RP group (p < 0.001). The ME-RP group showed significantly more attenuated functional responses than the no-ME-RP patients. A significant positive interaction was found between the CRT (zones 1 and 2) and the RNFL thickness within ME-RP (p ≤ 0.010). Significant negative interactions were found between CRT, RNFL thickness, and functional findings within ME-RP (p ≤ 0.049).

Conclusion The presence of macular oedema correlated well with increased RNFL thickness and residual function in RP patients. Such association provides evidence of an underlying transneuronal mechanism of retinal degeneration. Simultaneous monitoring of CRT and RNFL thickness may help in the future to evaluate the progression of the disease and the efficacy of treatments in RP patients.

Zusammenfassung

Ziel Zusammenhang zwischen zentraler Netzhautdicke (CRT) und retinaler Nervenfaserschichtdicke (RNFL) und Funktion bei Patienten mit Retinitis pigmentosa (RP).

Methode Eingeschlossen wurden Patienten mit typischer RP und eine altersgleiche Kontrollgruppe, die sich einem SD-OCT (Makula- und Sehnervenkopf-OCT) und Elektrophysiologie unterzogen. Die RP-Gruppe wurde in 2 Untergruppen aufgeteilt: mit klinischem Erscheinungsbild eines Makulaödems (ME-RP; 30 Augen) und ohne Makulaödem (no-ME; 44 Augen). Die Daten des Makula-OCT wurden in 3 Zonen (Zone 1 [0°–3°], Zone 2 [3°–8°] und Zone 3 [8°–15°]) gemittelt und in Bezug auf die RNFL-Dicke und elektrophysiologischen Daten ausgewertet.

Ergebnisse Die ME-RP-Gruppe zeigte eine erhöhte zentrale retinale Dicke (CRT) (Zone 1) und retinale Nervenfaserschichtdicke (RNFL) im Vergleich zur Kontroll- und no-ME-RP-Gruppe (p ≤ 0,002). Bei der Gruppe no-ME-RP war die CRT-Dicke (aller Zonen; p ≤ 0,018) im Vergleich zu den Kontrollen und der ME-RP reduziert, während die RNFL-Dicke in der Gruppe no-ME-RP nur im Vergleich zur ME-RP-Gruppe reduziert war (p < 0,001). Die ME-RP-Gruppe zeigte verglichen zu den no-ME-RP-Patienten eine signifikante Abschwächung der funktionellen Parameter. Es wurde eine signifikante positive Interaktion zwischen der CRT (Zone 1 und 2) und der RNFL-Dicke innerhalb der ME-RP-Gruppe gefunden (p ≤ 0,010). Signifikante negative Interaktionen wurden zwischen CRT-Dicke, RNFL-Dicke und funktionellen Veränderungen innerhalb der ME-RP-Gruppe (p ≤ 0,049) gefunden.

Schlussfolgerung Das Vorliegen eines Makulaödems korrelierte gut mit der Zunahme der RNFL-Dicke und residueller Funktion bei RP-Patienten. Eine solche Assoziation liefert Hinweise auf einen gemeinsam zugrunde liegenden transneuronalen Mechanismus der Netzhautdegeneration. Die gleichzeitige Überwachung der CRT- und RNFL-Dicke könnte in Zukunft helfen, das Fortschreiten der Krankheit und die Wirksamkeit von Behandlungen bei RP-Patienten zu beurteilen.

Key words

macular oedema - optical coherence tomography - retinitis pigmentosa - central retinal thickness - retinal nerve fibre layer thickness - retinal function

Schlüsselwörter

Makulaödem - optische Kohärenztomografie - Retinitis pigmentosa - zentrale Retinadicke - zentrale Nervenfaserschichtdicke - Netzhautfunktion

Full Text

References

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