ArticlesRetinal layer segmentation in multiple sclerosis: a systematic review and meta-analysis
Introduction
Optical coherence tomography (OCT) is a high-resolution imaging technique suitable for sophisticated postprocessing.1, 2 Since our last meta-analysis,3 use of time domain OCT (TD-OCT) has been overtaken by spectral domain OCT (SD-OCT) in clinical practice.4 The much higher resolution of SD-OCT now permits analysis of individual retinal layer thicknesses.5, 6, 7, 8 This improvement in technique has enabled segmentation of ten additional retinal layers next to the well investigated retinal nerve fibre layer (RNFL).9 Five of these layers have been analysed systematically in patients with multiple sclerosis: ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL). In the present meta-analysis, we aimed to investigate what additional information can be derived by retinal layer segmentation in patients with multiple sclerosis and with optic neuritis associated with multiple sclerosis.
Section snippets
Search strategy and selection criteria
This study was a systematic review and meta-analysis of the thickness of individual retinal layers in multiple sclerosis. AP and LJBalk did the review of the Dutch, English, French, German, Italian, and Spanish literature on all studies (cross-sectional and longitudinal) with OCT in patients with multiple sclerosis published between the first report of the method by Huang and colleagues1 on Nov 22, 1991, and April 19, 2016, including manuscripts published ahead of print. We searched PubMed, Web
Results
Figure 1 summarises the selection process for the 110 articles that reported SD-OCT in multiple sclerosis (the appendix has the full list of references). Of these, 40 articles6, 14, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 presented data suitable (in five cases after contacting the authors for additional information [stated as not estimable when data were not provided]) for
Discussion
In this meta-analysis, the data suggest that multiple sclerosis is associated with atrophy of retinal ganglion cells (GCL and GCIPL) and their axons (peripapillary RNFL and macular RNFL). Importantly, the effect sizes shown for the meta-analysis based on SD-OCT of the peripapillary RNFL almost exactly matched the effect sizes from our meta-analysis3 based on TD-OCT. This outcome emphasises the robustness and accuracy of the peripapillary RNFL as a measure for neurodegeneration in multiple
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