Structural retinal changes in cerebral small vessel disease

Abstract

Cerebral small vessel disease (CSVD) is an important contributor to cognitive impairment and stroke. Previous research has suggested associations with alterations in single retinal layers. We have assessed changes of all individual retinal layers in CSVD using high-resolution optical coherence tomography (OCT) for the first time. Subjects with recent magnetic resonance imaging (MRI) underwent macular and peripapillary retinal imaging using OCT for this case-control study. Number and volume ratio index (WMRI) of white matter lesions (WML) were determined on MRI. Data were analyzed using multiple linear regression models. 27 CSVD patients and 9 control participants were included. Ganglion cell layer (GCL) volume was significantly reduced in patients with CSVD compared to age-matched controls (p = 0.008). In patients with CSVD, larger foveal outer plexiform layer (OPL) volume and decreased temporal peripapillary retinal nerve fiber layer (RNFL) thickness were significantly associated with a higher WMRI in linear regression when controlling for age (p ≤ 0.033). Decreased foveal GCL volume and temporal-inferior RNFL thickness at Bruch's membrane opening (MRW), and increased temporal MRW were associated with a higher WML burden (p ≤ 0.037). Thus, we identified alterations in several OCT layers in individuals with CSVD (GCL, OPL, MRW and RNFL). Their potential diagnostic value merits further study.

Figure 1

T2 FLAIR images from a 75-year old participant with hyperintense lesions (Fazekas 3) due to cerebral small vessel disease. (A) T2 FLAIR image showing multiple hyperintense white matter lesions. (B) Results of the white matter lesions segmentation using the lesion prediction algorithm. The white matter lesions detected by the algorithm are presented in red-yellow.

Figure 2

Optical coherence tomography-images of 75-year old participant. (A) Macular scan—different macular layers are segmented; (B) RNFL-scan—the peripapillary retinal nerve fiber layer (pRNFL) is segmented; (C) BMO-scan—the arrows show the Bruch’s membrane opening-minimum rim width (MRW). RNFL retinal nerve fiber layer, GCL ganglion cell layer, IPL inner plexiform layer, INL inner nuclear layer, OPL outer plexiform layer, ONL outer nuclear layer, RPE retinal pigment epithelium.