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Retinal segmented layers with strong aquaporin-4 expression suffered more injuries in neuromyelitis optica spectrum disorders compared with optic neuritis with aquaporin-4 antibody seronegativity detected by optical coherence tomography
  1. Chun xia Peng1,
  2. Hong Yang Li2,
  3. Wei Wang3,
  4. Jun qing Wang1,
  5. Lei Wang1,
  6. Quan gang Xu4,
  7. Shan shan Cao1,
  8. Huan fen Zhou1,
  9. Shuo Zhao1,
  10. Shi hui Wei1
  1. 1Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
  2. 2Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  3. 3Zhongshan Ophthalmic Center, Sun yat-sen University, Guangzhou, China
  4. 4Neurology Department, Chinese PLA General Hospital, Beijing, China
  1. Correspondence to Dr Shi Hui Wei, Ophthalmology Department Chinese PLA General Hospital, Fuxing Road No. 28, Haidian District, Beijing, 100853, China; weishihui706{at}


Purpose To evaluate retinal segmented layer alterations in optic neuritis (ON) in an AQP4-Ab seropositive (AQP4-Ab+/ON) cohort and in neuromyelitis optica (NMO) with ON eyes (NMO-ON) compared with an AQP4-Ab seronegative ON (AQP4-Ab−/ON) cohort using optical coherence tomography (OCT).

Methods We recruited 109 patients with ON (161 eyes) and 47 healthy controls. All patients with ON were subdivided into three subcohorts: 37 patients (54 eyes) with AQP4-Ab+/ON, 45 patients (65 eyes) with AQP4-Ab−/ON and 27 patients (42 eyes) with NMO-ON. All subjects were evaluated for their peripapillary retinal nerve fibre layer (pRNFL) and inner macular segmented layer using OCT.

Results AQP4-Ab+/patients with ON had the same structural injury patterns as patients with NMO-ON, and the injury patterns were distinct from those of AQP4-Ab−/patients with ON. NMO-ON and AQP4-Ab+/ON preferentially damaged the pRNFL (all p=0.000), the macular retinal nerve fibre layer (mRNFL; p=0.000 and 0.032, respectively), and the inner plexiform layer (IPL; p=0.000 and 0.006, respectively) without differences in the retinal ganglion cell layer (p=0.106 and 0.374, respectively) compared with AQP4-Ab−/patients with ON. The thickness of the inner nuclear layer (INL) increased in NMO-ON (p=0.043) compared with that of AQP4-Ab−/ON without a significant difference in AQP4-Ab+/ON versus AQP4-Ab−/ON (p=0.353). When the thickness of the inferior nasal quadrant (NI) of the pRNFL was reduced to ≤46.5 μm (area under the curve 0.772, sensitivity 89.2% and specificity 57.5%) 6 months after ON onset, NMO was considered.

Conclusions AQP4-Ab+/ON produced similar structural injury patterns as NMO-ON. The pRNFL, mRNFL and IPL in the two types of ON and the INL in NMO-ON suffered more damage than those in AQP4-Ab−/ON, which could be associated with strong aquaporin-4 expression. The thickness of the NI of the pRNFL could be a potential clue for predicting ON progression to definite NMO.

  • Imaging
  • Optic Nerve
  • Retina
  • Pathology
  • Diagnostic tests/Investigation

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  • Chunxia Peng and Hongyang Li contributed equally.

  • Contributors CP and HYL are co-first authors and contributed equally. Design and conduct of the study by CP, HYL and SW. Collection, management, analysis and interpretation of the data by CP, LW, JW, SC, HZ and SZ. Preparation of the manuscript by CP, WW and QX. Critical revision of the manuscript was performed by CP and HL. Review and final approval of the manuscript by all the authors.

  • Funding This study was supported by the National High Technology Research and Development Program of China (863 Programme, NO. 2015AA020511).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was performed with the approval of the ethics committee of the Chinese People's Liberation Army General Hospital, and the study adhered to the Declaration of Helsinki (the 2013 revision), the guidelines of the International Conference on Harmonisation of Good Clinical Practice and applicable Chinese laws.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data involved in this study are owned by the Department of Ophthalmology of Chinese PLA General Hospital. If you want to share the data, please contact to Prof. Shi hui Wei (

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