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. 2025 Mar 1;272(3):237.
doi: 10.1007/s00415-025-12930-7.

Longitudinal analysis of retinal and choriocapillaris in patients with multiple sclerosis: a 3-year study

Mihai Bostan  1   2 , Chi Li  3 , Jia Wei Cheong  3 , Damon Wing Kee Wong  3   4   5 , Bingyao Tan  3   4   5 , Munirah Binte Ismail  3   4 , Gerhard Garhöfer  6 , Ruxandra Coroleuca  1   2 , Leopold Schmetterer  3   4   5   6   7   8   9   10 , Alina Popa-Cherecheanu  11   12 , Jacqueline Chua  13   14
Affiliations

Longitudinal analysis of retinal and choriocapillaris in patients with multiple sclerosis: a 3-year study

Mihai Bostan et al. J Neurol. .

Abstract

Objectives: This study investigated the longitudinal progression of retinal structure and microvasculature over 3 years in patients with relapsing-remitting multiple sclerosis (RRMS) using optical coherence tomography (OCT) and OCT angiography (OCTA). It also explored the correlation between these changes and the Expanded Disability Status Scale (EDSS) scores.

Methods: In this prospective, longitudinal study, we enrolled 66 patients with RRMS without history of optic neuritis and 124 healthy controls. All participants underwent full ophthalmological examination, OCT/OCTA scans, and disability scoring (EDSS) at baseline and after 12 and 24 months. OCT data were analyzed for retinal layer thickness, while OCTA assessed microvascular perfusion in the retinal capillary plexuses and choriocapillaris. Statistical models evaluated yearly rates of change and their association with EDSS scores.

Results: The patients with RRMS exhibited 3.6 times faster thinning of the inner plexiform layer (IPL; - 0.47 µm per year, P = 0.001) compared to controls over 3 years. Additionally, superficial retinal capillary layer perfusion density decreased more rapidly at - 0.44% per year (P = 0.006) in patients with MS. A strong correlation was found between worsening EDSS scores and accelerated ONL thinning (estimated coefficient: - 1.62 µm/per unit change of EDSS score, P = 0.004).

Discussion: This study demonstrates progressive retinal neurodegeneration and microvascular dysfunction in patients with RRMS without a history of optic neuritis. The association between ONL thinning and increased disability supports the potential of OCT/OCTA as valuable tools for monitoring disease progression and severity in RRMS.

Keywords: Expanded disability status scale; Microvascular dysfunction; Neurodegeneration; Optical coherence tomography; Optical coherence tomography angiography; Relapsing–remitting multiple sclerosis.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Framework of optical coherence tomography (OCT) image processing; A annulus mask applied onto macular OCT image for analysis; B and C corresponding B-scans, showing the surface of each retinal layer; D color code for ten retinal layers: retinal nerve fiber layer (RNFL); ganglion cell layer (GCL); inner plexiform layer (IPL); inner nuclear layer (INL); outer plexiform layer (OPL); outer nuclear layer (ONL); photoreceptor inner/outer segments (IS/OS); outer segment of photoreceptors (OSP); outer segment photoreceptor/retinal pigment epithelium complex (OPR); retinal pigment epithelium (RPE)
Fig. 2
Fig. 2
Framework of optical coherence tomography angiography (OCTA) image post-processing. A–C Raw OCTA images extracted from the OCTA machine. D Large vessels segmented and binarized from the superficial capillary plexus (SCP). E–F Foveal avascular zones (FAZ) are manually delineated from SCP and deep capillary plexus (DCP). G Choriocapillaris flow deficits binarized from the OCTA image by applying a mask to remove large vessel artifacts. H, I Vessels binarized from the SCP and DCP. FAZ regions were masked from the binarized images. J Fovea-centered annulus mask has an inner diameter of 1.0 mm and an outer diameter of 2.5 mm. K Choriocapillaris flow deficit density is obtained within the annulus mask. L, M Perfusion density is obtained by binarizing vascular images with an annulus mask. Dotted lines represent the overlay of masks
Fig. 3
Fig. 3
A significant association can be seen between worsening disability scores [Expanded Disability Status Scale (EDSS)] and a faster rate of thinning in the outer nuclear layer (ONL) of the retina in patients with relapsing–remitting multiple sclerosis
See this image and copyright information in PMC

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