PT  - JOURNAL ARTICLE
AU  - Motamedi, Seyedamirhosein
AU  - Oertel, Frederike C.
AU  - Yadav, Sunil K.
AU  - Kadas, Ella M.
AU  - Weise, Margit
AU  - Havla, Joachim
AU  - Ringelstein, Marius
AU  - Aktas, Orhan
AU  - Albrecht, Philipp
AU  - Ruprecht, Klemens
AU  - Bellmann-Strobl, Judith
AU  - Zimmermann, Hanna G.
AU  - Paul, Friedemann
AU  - Brandt, Alexander U.
TI  - Altered fovea in AQP4-IgG–seropositive neuromyelitis optica spectrum disorders
AID  - 10.1212/NXI.0000000000000805
DP  - 2020 Sep 01
TA  - Neurology - Neuroimmunology Neuroinflammation
PG  - e805
VI  - 7
IP  - 5
4099  - http://nn.neurology.org/content/7/5/e805.short
4100  - http://nn.neurology.org/content/7/5/e805.full
SO  - Neurol Neuroimmunol Neuroinflamm2020 Sep 01; 7
AB  - Objective To investigate disease-specific foveal shape changes in patients with neuromyelitis optica spectrum disorders (NMOSDs) using foveal morphometry.Methods This cross-sectional study included macular spectral domain optical coherence tomography scans of 52 eyes from 28 patients with aquaporin-4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD, 116 eyes from 60 patients with MS, and 123 eyes from 62 healthy controls (HCs), retrospectively, and an independent confirmatory cohort comprised 33/33 patients with NMOSD/MS. The fovea was characterized using 3D foveal morphometry. We included peripapillary retinal nerve fiber layer (pRNFL) thickness and combined macular ganglion cell and inner plexiform layer (GCIPL) volume to account for optic neuritis (ON)-related neuroaxonal damage.Results Group comparison showed significant differences compared with HC in the majority of foveal shape parameters in NMOSD, but not MS. Pit flat disk area, average pit flat disk diameter, inner rim volume, and major slope disk length, as selected parameters, showed differences between NMOSD and MS (p value = 0.017, 0.002, 0.005, and 0.033, respectively). This effect was independent of ON. Area under the curve was between 0.7 and 0.8 (receiver operating characteristic curve) for discriminating between NMOSD and MS. Pit flat disk area and average pit flat disk diameter changes independent of ON were confirmed in an independent cohort.Conclusions Foveal morphometry reveals a wider and flatter fovea in NMOSD in comparison to MS and HC. Comparison to MS and accounting for ON suggest this effect to be at least in part independent of ON. This supports a primary retinopathy in AQP4-IgG–seropositive NMOSD.AQP4-IgG=aquaporin-4 immunoglobulin G; ART=automatic real time; AUC=area under the curve; B=estimate; FT=foveal thickness; GCIPL=combined macular ganglion cell and inner plexiform layer; HC=healthy control; ILM=inner limiting membrane; INL=inner nuclear layer; MOG=myelin oligodendrocyte glycoprotein; NMOSD=neuromyelitis optica spectrum disorder; OCT=optical coherence tomography; ON=optic neuritis; ON−=eyes without a history of ON; ON+=eyes with a history of ON; pRNFL=peripapillary retinal nerve fiber layer; ROC=receiver operating characteristic; SE=standard error of B