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      Peripapillary and parafoveal vascular network assessment by optical coherence tomography angiography in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders

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          Abstract

          Background/aims

          Current understanding of the alterations in the retinal vascular network in neuromyelitis optica spectrum disorders (NMOSDs) is limited. We aim to assess the peripapillary and parafoveal vessel density in aquaporin-4 antibody-positive NMOSD patients by optical coherence tomography (OCT) angiography.

          Methods

          A total of 55 aquaporin-4 antibody-positive NMOSD patients with or without a history of optic neuritis (ON) and 33 healthy controls underwent spectral domain OCT and OCT angiography. Clinical histories, Expanded Disability Status Scale score, visual functional system score (VFSS) and disease duration were collected.

          Results

          Peripapillary and parafoveal vessel density was significantly decreased in NMOSD eyes with or without a history of ON. The decrease in retinal vessel density could occur before ON and retinal nerve fibre layer (RNFL) atrophy. Peripapillary vessel density correlated well with the spectral domain OCT measurements and VFSS in NMOSD eyes with a history of ON.

          Conclusion

          Subclinical primary retinal vasculopathy may occur in NMOSD prior to ON and RNFL atrophy. Peripapillary vessel density might be a sensitive predictor of visual outcomes in NMOSD patients with ON.

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          Most cited references17

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          Tuned responses of astrocytes and their influence on hemodynamic signals in the visual cortex.

          Astrocytes have long been thought to act as a support network for neurons, with little role in information representation or processing. We used two-photon imaging of calcium signals in the ferret visual cortex in vivo to discover that astrocytes, like neurons, respond to visual stimuli, with distinct spatial receptive fields and sharp tuning to visual stimulus features including orientation and spatial frequency. The stimulus-feature preferences of astrocytes were exquisitely mapped across the cortical surface, in close register with neuronal maps. The spatially restricted stimulus-specific component of the intrinsic hemodynamic mapping signal was highly sensitive to astrocyte activation, indicating that astrocytes have a key role in coupling neuronal organization to mapping signals critical for noninvasive brain imaging. Furthermore, blocking astrocyte glutamate transporters influenced the magnitude and duration of adjacent visually driven neuronal responses.
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            Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis.

            Recognizing the cause of optic neuritis (ON) affects treatment decisions and visual outcomes.
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              Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography

              Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients’ RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.
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                Author and article information

                Journal
                Br J Ophthalmol
                Br J Ophthalmol
                bjophthalmol
                bjo
                The British Journal of Ophthalmology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0007-1161
                1468-2079
                June 2019
                18 July 2018
                : 103
                : 6
                : 789-796
                Affiliations
                [1 ] departmentDepartment of Ophthalmology , Eye and ENT Hospital, Shanghai Medical College, Fudan University , Shanghai, China
                [2 ] departmentDepartment of Neurology , Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai, China
                [3 ] departmentDepartment of Neurology , Jing’an District Centre Hospital of Shanghai , Shanghai, China
                Author notes
                [Correspondence to ] Dr Chao Quan, Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China; chao_quan@ 123456fudan.edu.cn ; Dr Min Wang, Department of Ophthalmology, Eye and ENT hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China; wangmin83@ 123456yahoo.com
                Author information
                http://orcid.org/0000-0003-1040-3930
                Article
                bjophthalmol-2018-312231
                10.1136/bjophthalmol-2018-312231
                6582722
                30021816
                183b1fa6-9d87-4f40-840d-e4b9e848b69c
                © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 12 March 2018
                : 20 June 2018
                : 25 June 2018
                Funding
                Funded by: National Key Research and Development Program of China;
                Award ID: 2016YFC0901504
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81771296
                Categories
                Clinical Science
                1506
                Custom metadata
                unlocked

                Ophthalmology & Optometry
                neuromyelitis optica spectrum disorders (nmosd),optic neuritis (on),optical coherence tomography angiography

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