MULTİPLE SKLEROZDA OPTİK KOHERENS TOMOGRAFİ İLE RETİNA SİNİR LİFİ TABAKASININ DEĞERLENDİRİLMESİ Evaluation of Retina Nerve Fiber Layer with Optical Coherence Tomography in Multiple Sclerosis

Amac: Multiple skleroz (MS) hastalarinda spektral optik koherens tomografi (OKT) ile retina sinir lifi tabakasi(RSLT) kalinligini olcmek ve bu degerlerle hastalarin genisletilmis ozurluluk durum olceginin (EDSS) iliskisini degerlendirmektir. Gerec ve Yontem: Bu ileri donuk calismada iki grup olusturuldu. Calismaya noroloji kliniginde Mc Donald kriterlerine gore multiple skleroz tanisi konmus, takip edilen ve aktif hastaligi olmayan 30 hastanin 30 gozu ve 33 saglikli kontrol grubunun 33 gozu dahil edildi. Noroloji kliniginde multiple skleroz hastalarina genisletilmis ozurluluk durum olceginin testi yapildi. Tum hastalara tam detayli oftalmolojik muayene yapildiktan sonra spektral optik koherens tomografi ile temporal,nasal.inferior ve superior kadranlarda retina sinir lifi tabakasi kalinliklari incelendi. Her iki grupta da okuler patoloji saptanan ve okuler hastalik hikayesi olan hastalar calisma disinda birakildi. Sonuclar: Hasta ve kontrol grubunun yas ve cinsiyet dagilimi acisindan birbirinden farki yoktu(p<0,005). Istatiksel olarak iki grup arasinda dort kadranda da anlamli fark bulundu. Sirasiyla; hastalarin temporal retina sinir lifi tabakasi kalinligi ortalamasi 77,93 ±7,71μm, kontrol grubunun 83,66 ±5,16μm (p=0.001); hastalarin nasal retina sinir lifi tabakasi kalinligi ortalamasi 76,76 ±6,43 μm, kontrol grubunun 80,18 ±4,17μm (p=0.014); hastalarin superior retina sinir lifi tabakasi kalinligi ortalamasi 120,26 ±11,84μm, kontrol grubunun 126,90±10,33μm (p=0.021); hastalarin inferior retina sinir lifi tabakasi kalinligi ortalamasi 124,83 ±12,00 μm, kontrol grubunun ise 133,12 ±12,77 μm (p=0.010) idi. multiple skleroz hastalarina yapilan genisletilmis ozurluluk durum olceginin testinin ortalamasi 2,46±1.83 olarak bulundu. Genisletilmis ozurluluk durum olceginin sonuclariyla temporal (p<0.001,r= -0.724) ve nasal (p<0.001,r= -0.777) retina sinir lifi tabakasi kadranlari arasinda anlamli ve yuksek duzeyde negatif korelasyon; superior(p=0.001,r= -0.562) ve inferior(p=0.004,r= -0,515) retina sinir lifi tabakasi kadranlari arasinda anlamli ve orta duzeyde negatif korelasyon oldugunu tespit ettik. Tartisma: Multiple skleroz hastalarinda retina sinir lifi tabakasi kalinliginda azalma olmaktadir. Bu azalmada genisletilmis ozurluluk durum olceginin skoruyla korele sekilde gerceklesmektedir. Optik koherens tomografi ile retina sinir lifi tabakasi olcumu, klinik olarak ortaya cikmamis norodejenerasyonun tespitinde, tedavinin izleminde ve takipte yardimci bir yontem olabilir. Anahtar Kelimeler: Multiple skleroz; optik koherens tomografi; retina sinir lifi tabakasi; optik norit ABSTRACT Aim: To measure the thickness of the retinal nerve fiber layer (RNFL) with spectral optical coherence tomography (OCT) in patients with multiple sclerosis (MS) and to evaluate the correlation between these values and the calculated extended disability status scale (EDSS) of the patient. Material and Method: Two groups were formed in this prospective study. Thirty eyes of 30 patients who were diagnosed with multiple sclerosis according to Mc Donald criteria in neurology clinic and without active disease and 33 eyes of 33 healthy controls were included in the study. Extended disability status scale test was performed in the neurology clinic. After all patients underwent a fully detailed ophthalmological examination and the spectral optical coherence tomography examine retinal nerve fiber layer thicknesses in the temporal, nasal, inferior and superior quadrants. Patients with a history of ocular disease in both groups were excluded from the study. Results: There was no difference between the patient and control groups in terms of age and gender distribution (p <0.005). Statistically significant differences were found between the two groups in four quadrants. Respectively; the mean temporal retinal nerve fiber layer thickness of the patients was 77,93 ± 7,71 μm, and the control group had 83,66 ± 5,16 μm (p = 0.001); nasal retinal nerve fiber layer thickness of the patients was 76,76 ± 6,43 μm and 80,18 ± 4,17 μm in the control group (p = 0.014); the mean superior retinal nerve fiber layer thickness of the patients was 120.26 ± 11.84μm and the control group was 126.90 ± 10.33 μm (p = 0.021); the mean inferior retinal nerve fiber layer thickness of the patients was 124,83 ± 12,00 μm and the control group was 133,12 ± 12,77 μm (p = 0.010). Statistically significant difference was found between the two groups in four quadrants. The mean value of extended disability status scale was 2.46 ± 1.83 for multiple sclerosis patients. A significant and high negative correlation was found between the extended disability status scale results of the temporal (p <0.001, r = -0.724) and nasal (p <0.001, r = -0.777) retinal nerve fiber layer quadrants; we found a significant and moderate negative correlation between the superior (p = 0.01, r = -0.562) and inferior (p = 0.04, r = -0,515) retinal nerve fiber layer quadrants. Discussion: There is a decrease in retinal nerve fiber layer thickness in multiple sclerosis patients. This decrease is correlated with extended disability status scale score. Measurement of retinal nerve fiber layer with optical coherence tomography may be an adjunctive method in the detection, clinical follow-up, and follow-up of clinically unresolved neurodegeneration. Key Words: Multiple sclerosis; optical coherence tomography; retinal nerve fiber layer; optic neurit