Optical coherence tomography findings in multiple sclerosis and comparison with Primary Sjögren’s syndrome

doi:10.21203/rs.3.rs-8139231/v1

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Optical coherence tomography findings in multiple sclerosis and comparison with Primary Sjögren’s syndrome

https://doi.org/10.21203/rs.3.rs-8139231/v1

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Background

Primary Sjögren’s syndrome (PSS) with central nervous system (CNS) involvement can mimic multiple sclerosis (MS). Optical coherence tomography (OCT) quantifies retinal neuroaxonal damage and may assist differential diagnosis.

Methods

In this case–control study, 170 eyes (60 from participants with MS, 56 from PSS, and 54 from healthy controls [HCs]) were examined with OCT. Peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and foveal, parafoveal and perifoveal retinal thicknesses and foveal volume were measured. Group comparisons, including subgroup analyses of MS with and without previous optic neuritis (ON) and PSS with CNS involvement, used parametric or non-parametric tests (significance p < 0.05).

Results

Whole RNFL and GCC thickness were significantly lower in MS than in PSS and HCs, with RNFL thinning in all quadrants except nasal. MS showed lower parafoveal and perifoveal retinal thickness and reduced foveal volume compared to PSS and HCs. When MS was compared with PSS with CNS involvement, parafoveal thickness remained significantly lower in MS, whereas other OCT parameters were similar. In three-group analyses, MS with prior ON showed the most pronounced parafoveal and perifoveal thinning versus MS without ON and PSS with CNS involvement, while MS without ON did not differ from PSS with CNS involvement.

Conclusions

OCT demonstrates more extensive retinal neuroaxonal damage in MS than in PSS and HCs, especially in peripapillary RNFL and parafoveal/perifoveal macula. These findings support the potential role of OCT in differentiating MS from PSS with CNS involvement and in identifying MS patients with more severe neuroaxonal injury.

Neurology

multiple sclerosis

primary Sjögren’s syndrome

optical coherence tomography

retinal nerve fiber layer

optic neuritis

Multiple sclerosis (MS) is an immune-mediated inflammatory disease of the central nervous system characterized by demyelination, axonal loss, and neurodegeneration. The disease course is heterogeneous, and both clinical attacks and subclinical activity contribute to irreversible disability. Optic neuritis (ON) is one of the most frequent manifestations of MS, and visual pathway involvement is considered a model to study neurodegeneration in this disease (1–4). Optical coherence tomography (OCT) studies have shown that retinal neuroaxonal loss can be detected even in eyes without a history of ON in most patients (5).

Magnetic resonance imaging (MRI) is widely used in the diagnosis and follow-up of MS and is an integral part of the current diagnostic criteria. However, MRI findings can be nonspecific and may be difficult to interpret in patients with comorbidities or in conditions that mimic MS, such as autoimmune connective tissue diseases with central nervous system (CNS) involvement. In such situations, MRI alone may be insufficient for accurate differential diagnosis, which underlines the need for additional, easily applicable biomarkers to support clinical decision making.

Optical coherence tomography (OCT) is a non-invasive imaging method that provides high-resolution cross-sectional images of the retina and peripapillary retinal nerve fiber layer (RNFL). Because the retina is an anatomically accessible part of the CNS, OCT has emerged as a useful tool to quantify neuroaxonal damage in MS and other inflammatory or degenerative disorders (6). In addition, primary Sjögren’s syndrome (PSS) may also present with CNS involvement and MS-like symptoms, which can lead to diagnostic uncertainty. In this context, retinal structural measurements obtained by OCT may potentially contribute to differentiating MS from PSS and from healthy individuals. Therefore, in the present study we evaluated peripapillary RNFL and macular thickness parameters in patients with MS, patients with PSS, and healthy controls to investigate the potential role of OCT in the differential diagnosis of MS.

Study design and participants

The present study was designed as a case-control study. A total of 170 eyes were evaluated, 60 from MS participants, 56 from PSS participants, and 54 from healthy controls (HCs), by evaluating both eyes of each participant in the study. MS patients followed up in the Neurology Multiple Sclerosis unit and met the revised criteria of McDonald 2017 (7). PSS patients were those who were under rheumatology outpatient follow-up and met the 2016 ACR/EULAR criteria (8). Healthy controls (HCs) were hospital staff. Approval was obtained from the local ethics committee (2011-KAEK-25 2018/07–30) and written consent was obtained from all participants. The procedures of the study were designed and implemented in accordance with the Helsinki Declaration.

Inclusion and exclusion criteria

Volunteers over the age of 18 and under the age of 65 were included. Participants with pregnancy or cancer were excluded. All MS participants included in the study have relapsing-remitting form and MS patients who had flare in last 3 months were not included in the study. Those with a history of ocular trauma or surgery, media opacity due to cataract or corneal disorder, and those with uveitis, diabetic retinopathy or macular degeneration were excluded from the study. In addition, those with cylindrical refractor error greater than 2.00 diopters, spherical refractor error greater than 4.00 diopters, intraocular blood pressure greater than 21 mmHg and those with poor signal quality (signal strength < 60) were excluded from the study.

Study procedures

Initial evaluation

Demographic data of all participants were recorded. Disease onset age, symptoms, medications, autoantibody tests (anti-nuclear antibody (ANA), anti-Sjögren’s syndrome A (SSA), anti-Sjögren’s syndrome B (SSB), rheumatoid factor) and pathology results of participants were obtained from the records. Cranial magnetic resonance images (MRI) taken previously of PSS and MS participants were evaluated by accessing the records in the PACS system. Neurological examinations of all participants were performed, and cranial MR images of PSS participants and MR images of MS participants were evaluated by a multiple sclerosis specialist neurologist (MS). PSS participants with focal/multifocal or diffuse hyperintense lesions in paraventricular or subcortical white matter on T2 sequences on brain MRI were considered PSS participants with CNS involvement. Ophthalmological examinations were performed by a specialist neuro-ophthalmologist (NPY). Patients with MS who were previously diagnosed with ON according to neuro-ophthalmologic examination and electrophysiologic findings and whose current anamnesis and ophthalmologic assessment were compatible with a previous ON attack were included in the subgroup of MS participants with ON. The level of disability of MS participants was evaluated with the Expanded Disability Status Scale (EDSS) (9).

Optical coherence tomography

Fourier-Domain Optical Coherence Tomography (OCT) device (RTVue-XR Avanti; Optovue Inc, Fremont, CA), an ultrahigh resolution OCT device, was used for measurements. This system operates with a wavelength of 840 nm and has an axial scanning speed of 70,000 per second and a resolution of 5 µm. OCT measurements were made by a single ophthalmologist (NPY) in both eyes after pupil dilation was provided with 1% tropicamide, and measurements with a signal strength indicator (SSI) of 60 and above were considered reliable and used for analysis. OCT measurements were made with 3 protocols: peripapillary, ganglion cell complex (GCC) and macula protocols. In the peripapillary protocol, the thickness of retinal nerve fiber layer (RNFL) was measured in a 3.45 mm diameter circular section with the optic disc in the center as a standard protocol. The thickness of the RNFL was measured in the whole area and in the superior, inferior, nasal and temporal regions. In the GCC protocol, GCC thickness in the macula was measured in the whole area and in the superior and inferior regions. In the macula protocol, retinal thickness was measured in the areas of the fovea, parafovea and perifovea, which are the regions defined by the Early Treatment of Diabetic Retinopathy Study. Retinal thickness was measured in the superior, inferior, nasal and temporal regions of the parafovea and perifovea areas. In the fovea area, retinal thickness and volume was measured only in the whole area.

Statistical analysis

Statistical analyzes were performed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). The normality of all data was evaluated using the Kolmogorov Smirnov or Shapiro-Wilk test. T-test was used to compare the quantitative data with normal distribution between 2 groups, and Mann-Whitney U test was used in cases where there was no normal distribution. In the comparison of quantitative data between 3 groups, ANOVA test was used when there was normal distribution, and Kruskal-Wallis test was used when there was no normal distribution. Tukey test was used in post hoc analysis. Chi-square (χ²) test was used to compare qualitative data. As statistical significance p < 0.05 was accepted.

Characteristics of the participants

Demographic data, clinical and laboratory characteristics of MS participants, and the drugs they use is shown in Table-1. The mean age of MS participants was 42.5 ± 6.4 years, and most of them were female (86.7%). Demographic data and clinical, laboratory and salivary gland pathological results of PSS participants, and the drugs they use is shown in Table-2. The mean age of PSS participants was 47.2 ± 6.6 years, and all of them were female. Minor salivary gland biopsy results of 21 PSS patients were evaluable, and grade 3–4 sialadenitis was detected in 17 of them. The mean age of HCs was 46.5 ± 10.5 years, and 24 of them were female (88.9%). Gender distributions of MS participants were not different from PSS participants and HCs (p = 0.113, p = 0.799, respectively). However, the mean age of MS participants was different from PSS participants (p = 0.008), but not from HCs (p = 0.096).

Optical coherence tomography parameters

Comparison of MS participants with PSS participants and healthy individuals

Comparison of OCT measurements of MS participants with PSS participants and HCs is shown in Table-3 and with a summary in Fig. 1. Whole RNFL thickness was 88.8 ± 12.5, 101.3 ± 10.0 and 98.1 ± 8.8 µm in MS participants, PSS participants and HCs, respectively, and was significantly lower in MS participants than in PSS participants and HCs (p < 0.001, p < 0.001, respectively). RNFL thickness was found to be significantly lower in MS participants than in PSS participants and HCs in all RNFL regions (superior, inferior, temporal) except the nasal region. Whole GCC thickness was 85.8 ± 14.4, 95.7 ± 6.9 and 95.6 ± 7.1 µm in MS participants, PSS participants and HCs, respectively, and was significantly lower in MS participants than in PSS participants and HCs (p < 0.001, p < 0.001, respectively). Foveal thickness was 244.7 ± 19.1, 249.7 ± 22.2 and 256.2 ± 18.6 µm in MS participants, PSS participants and HCs, respectively, and was not different from PSS participants in MS participants (p = 0.378) but was lower than in HCs (p = 0.002). Retinal thickness in the parafoveal area was significantly lower in MS participants than in PSS participants and HCs in all regions (inferior, superior, nasal, temporal). Retinal thickness in the perifoveal area was significantly lower in MS participants in the inferior, superior and nasal regions than in PSS participants and HCs. However, although retinal thickness in the temporal region of the perifoveal area was significantly lower in MS participants than in PSS participants (p = 0.008), it was not different from that in HCs (p = 0.067). Foveal volume was 6.95 ± 0.51, 7.33 ± 0.75, and 7.19 ± 0.34 mm³ in MS participants, PSS participants, and HCs, respectively, and was lower in MS participants than in PSS participants and HCs (p = 0.001, p = 0.003, respectively).

Figure 1: Schematic representation of RNFL and macular thickness in HC, PSS and MS

Comparison of MS participants and PSS participants with CNS involvement

Comparison of OCT measurements of MS participants and PSS participants with CNS involvement is shown in Table-4. Whole RNFL thickness was 88.8 ± 12.5 and 93.1 ± 11.9 µm in MS participants and PSS participants with CNS involvement, respectively. Whole GCC thickness was 85.8 ± 14.4 and 90.9 ± 6.2 µm in MS participants and PSS participants with CNS involvement, respectively. Foveal thickness was 244.7 ± 19.1 and 255.4 ± 35.9 µm in MS participants and PSS participants with CNS involvement, respectively. Retinal thickness in the RNFL, GCC, fovea and perifovea areas was not different in MS participants than in PSS participants with CNS involvement in any region. However, retinal thickness in the superior, inferior, and temporal regions of the parafovea area was significantly lower in MS participants than in PSS participants with CNS involvement (p = 0.031, p = 0.017, and p = 0.012, respectively). Foveal volume was 6.95 ± 0.51 and 7.27 ± 0.63 mm³ in MS participants and PSS participants with CNS involvement, respectively, and the difference was not significant (p = 0.097). Comparison of OCT measurements between MS participants with and without ON and participants with PSS with CNS involvement is shown in Table-5. RNFL and GCC thickness was not different between PSS participants with CNS involvement and MS participants with or without ON in any region. Retinal thickness in parafovea and perifovea areas was different between 3 groups in all regions. In post hoc analysis, retinal thickness was found to be lower in the nasal and temporal regions of both parafovea (p = 0.024 and p = 0.040, respectively) and perifovea (p = 0.018 and p = 0.016, respectively) areas in MS patients with ON than in MS patients without ON. Compared with PSS participants with CNS involvement, MS participants with ON exhibited significantly reduced retinal thickness in the superior (p = 0.026), inferior (p = 0.017), and nasal (p = 0.039) parafoveal regions, as well as in the inferior (p = 0.019), nasal (p = 0.001), and temporal (p = 0.001) perifoveal regions. In the comparison between MS participants without ON and PSS participants with CNS involvement, retinal thickness was not different in any region of any area. While retinal thickness in the foveal area was not different between groups, foveal volume was found to be lower in MS participants with ON than in PSS participants with CNS involvement (p = 0.017).

In clinical practice, several disorders with CNS involvement can mimic MS both clinically and radiologically. Among them, autoimmune connective tissue diseases such as primary Sjögren’s syndrome may present with white matter lesions, episodes suggestive of demyelination, or even optic neuritis, which can lead to misdiagnosis. In such scenarios, additional biomarkers that reflect neuroaxonal damage and can be obtained in a quick and non-invasive manner are highly desirable. OCT has been proposed as one such tool, because it allows direct visualization and quantification of retinal layers that correspond to unmyelinated axons and neurons of the CNS. On this basis, we aimed to investigate whether OCT parameters could help distinguish MS from PSS and from healthy individuals.

Our study showed RNFL thickness was found to be significantly lower in MS participants than in PSS participants and HCs in all RNFL regions (superior, inferior, temporal) except the nasal region. Whole GCC thickness was significantly lower in MS participants than in PSS participants and HC. Foveal volume was lower in MS participants than in PSS participants and HCs. When MS patients were compared with PSS with CNS involvement; retinal thickness were found to be lower only in the parafoveal region in MS patients. Also foveal volume was found to be lower in MS participants with ON than in PSS participants with CNS involvement (p = 0.017).

OCT findings were similar when MS patients without ON and PSS patients with CNS lesions were compared. In MS patients with ON, retinal thicknesses were found to be lower in the parafoveal and perifoveal area in MS patients compared to PSS patients with CNS lesions. When the retinal thicknesses of all MS patients and PSS patients with CNS lesions were compared, retinal thickness was found to be lower in the parafoveal region in MS patients. It can be interpreted that the parafoveal region is prominent in the differential diagnosis of MS patients from PSS patients with CNS involvement. Parafoveal region seems to be important in differential diagnosis of MS.

Our findings are in line with previous work that evaluated OCT for the differential diagnosis of MS and autoimmune connective tissue diseases with CNS involvement. In the study by Wildner et al., OCT measurements were compared among MS patients, patients with CNS involvement in connective tissue diseases, and healthy controls, and significant group effects were demonstrated for peripapillary RNFL and macular parameters, supporting the concept that retinal structural changes may reflect disease-specific patterns of CNS injury [10]. Similar to that study, we observed that MS patients showed more pronounced RNFL thinning than PSS participants and healthy controls, particularly in the superior, inferior, and temporal quadrants, whereas the nasal quadrant was relatively preserved.

OCT has substantially improved our understanding of the pathophysiological mechanisms in MS. Several studies have shown that thinning of the RNFL and ganglion cell–inner plexiform layer (GCIPL) occurs not only after ON but also in eyes without a history of optic nerve inflammation, indicating that retinal neuroaxonal loss is a diffuse manifestation of CNS pathology rather than a purely local phenomenon. These structural changes correlate with visual dysfunction and, in many reports, with global measures of disability, supporting the use of OCT as a biomarker of neurodegeneration in MS (11). The observation of RNFL and macular thinning in our MS cohort, including eyes without ON, is consistent with this concept.

Recent revisions of the McDonald diagnostic criteria (2024) have now formally incorporated the visual system into the diagnostic framework (12). The optic nerve is recognized as a fifth topographic site for dissemination in space, and abnormal findings on orbital MRI, visual evoked potentials or OCT can all provide paraclinical evidence of optic nerve involvement when no better explanation exists. Within these revisions, OCT-derived inter-eye differences in peripapillary RNFL and macular ganglion cell–inner plexiform layer thickness are specifically recommended as supportive measures to document unilateral optic nerve damage. In this updated context, our results suggest that quantitative retinal structural measurements obtained by OCT not only reflect neuroaxonal damage in MS but may also help to document optic nerve involvement and to distinguish MS from PSS with CNS involvement in diagnostically challenging cases, especially when conventional MRI findings are equivocal (12, 13).

Beyond structural OCT, optical coherence tomography angiography (OCTA) has emerged as a promising technique to assess retinal microvasculature in systemic autoimmune diseases. Several studies have reported reduced vessel density in the superficial and deep capillary plexus in MS and in PSS, even in the absence of overt ocular disease. Recently, Wolf et al. used OCTA to directly compare patients with relapsing–remitting MS and patients with PSS and demonstrated distinct patterns of retinal vascular alteration in the two diseases, suggesting that MS and PSS are associated with different retinal pathologies at the microvascular level (10, 11). Although our study did not include OCTA measurements, the structural thinning of RNFL and macular layers that we observed in MS compared with PSS and healthy controls may represent the neuroaxonal counterpart of these microvascular abnormalities.

This study has some limitations that should be acknowledged. The study population was of moderate size and the subgroup of PSS patients with CNS involvement was relatively small, which may have limited our ability to detect more subtle differences in OCT parameters between the groups. In addition, the single-center, cross-sectional design does not capture longitudinal change and may restrict the generalizability of the results. We also focused exclusively on structural OCT measures and did not include OCT angiography, so possible microvascular alterations could not be directly evaluated in this cohort. Finally, although key demographic and clinical factors were considered, the influence of unmeasured confounders cannot be completely excluded. These considerations may help to guide future research, including larger multicenter cohorts and longitudinal studies that combine structural OCT with OCT angiography to further clarify the diagnostic and prognostic value of retinal imaging in MS and PSS.

Our findings, in concordance with previous reports, indicate that OCT-derived retinal biomarkers may assist in differentiating MS, PSS with CNS involvement, and healthy individuals. Structural OCT yields quantitative measures of neuroaxonal damage, whereas OCTA provides complementary information on retinal microvascular alterations. Future studies that integrate both modalities in larger cohorts with longitudinal follow-up are warranted to clarify the interplay between structural and vascular retinal changes and to determine whether their combined use can enhance the early and accurate diagnosis of MS in patients with overlapping clinical or radiological features.

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Table-1: Demographic data, clinical and laboratory characteristics of MS participants, and the drugs they use.
	mean ± SD	Median	min-max
Age at disease onset	31.7 ± 7.5	31.5	18.0–48.0
Age	42.5 ± 6.4	41.5	33.0–64.0
Disease duration, years	10.8 ± 5.7	10.0	1.0–22.0
Flairs/year	0.5 ± 0.9	0.0	0.0–3.0
Treatment duration, years	9.0 ± 6.0	9.5	0.0–20.0
EDSS	2.3 ± 1.5	2.0	0.0-5.5
Frequencies, n (%)
Female	26 (86.7)
Clinic at disease onset
mono-symptomatic	8 (26.7)
poly-symptomatic	22 (73.3)
Optic neuritis
not present	11 (36.7)
right	3 (10.0)
left	5 (16.7)
bilateral	11 (36.7)
Drugs
interferon-β	9 (30.0)
fingolimod	8 (26.7)
glatiramer acetate	5 (16.7)
teriflunomide	3 (10.0)
rituximab	1 (3.3)
no medication	4 (13.3)
MS: Multiple sclerosis, SD: standard deviation, min: minimum, max: maximum, EDSS: Expanded Disability Status Scale.

Table-2: Demographic data and clinical, laboratory and salivary gland pathological results of PSS participants, and the drugs they use.
	mean ± SD	median	min-max
Age at disease onset, years	40.5 ± 9.7	40.5	17.0–55.0
Age, years	47.2 ± 6.6	45.5	33.0–58.0
Disease duration, years	6.7 ± 5.5	5.0	2.0–23.0
Female, n (%)	28 (100)
Sicca symptoms, n (%)
oral	22 (78.6)
ocular	24 (85.7)
Raynaud, n (%)	7 (25.0)
CNS involvement, n (%)	7 (25.0)
Minor salivary gland biopsy^‡, n = 21
grade 0	2
grade 1	1
grade 2	1
grade 3	5
grade 4	12
Antibodies, positive, n (%)
ANA	27 (96.4)
Anti-SSA	22 (78.6)
Anti-SSB	10 (35.7)
RF	12 (42.9)
Drugs, n (%)
hydroxychloroquine	26 (92.9)
pilocarpine	2 (7.1)
methotrexate	3 (10.7)
corticosteroids	16 (57.1)
azathioprine	5 (17.9)
pregabalin	7 (25.0)
duloxetine	4 (14.3)
PSS: Primary Sjögren's syndrome, SD: standard deviation, CNS: central nerves system, ^‡according to Chisholm score, ANA: antinuclear antibody, SSA: Sjögren’s syndrome A, SSB: Sjögren’s syndrome B, RF: Rheumatoid factor.

Table-3: Comparison of OCT measurements of MS participants patients with PSS participants and HCs.
	MS (n = 60)			PSS (n = 56)			HCs (n = 54)			p1	p2
Thickness, mean ± SD
RNFL, µm	88.8	±	12.5	101.3	±	10.0	98.1	±	8.8	0.000	0.000
inferior	100.5	±	19.0	116.2	±	19.6	118.4	±	11.1	0.000	0.000
superior	101.9	±	17.7	116.6	±	18.1	118.6	±	14.2	0.000	0.000
nasal	76.6	±	20.4	79.2	±	10.5	81.0	±	17.4	0.400	0.238
temporal	63.7	±	14.6	76.1	±	11.3	74.8	±	10.2	0.000	0.000
GCC, µm	85.8	±	14.4	95.7	±	6.9	95.6	±	7.1	0.000	0.000
superior	85.1	±	13.5	95.4	±	7.3	95.2	±	7.6	0.000	0.000
inferior	86.5	±	15.7	95.9	±	7.0	96.4	±	6.8	0.000	0.000
Fovea, µm	244.7	±	19.1	249.7	±	22.2	256.2	±	18.6	0.378	0.002
Parafovea, µm
inferior	305.3	±	39.0	320.7	±	45.6	314.6	±	16.2	0.001	0.000
superior	300.1	±	37.5	323.2	±	45.3	317.1	±	16.2	0.000	0.000
nasal	299.2	±	23.1	320.9	±	46.3	315.2	±	16.5	0.000	0.000
temporal	291.2	±	23.5	311.8	±	41.3	305.7	±	16.6	0.000	0.001
Perifovea, µm
inferior	270.5	±	21.9	284.8	±	32.6	277.4	±	14.9	0.003	0.021
superior	278.4	±	19.4	293.3	±	26.9	286.9	±	14.3	0.001	0.009
nasal	287.1	±	26.2	303.2	±	34.3	300.5	±	16.3	0.000	0.000
temporal	271.0	±	25.8	281.6	±	25.3	275.5	±	15.3	0.008	0.067
FV, mm³, mean ± SD	6.95	±	0.51	7.33	±	0.75	7.19	±	0.34	0.001	0.003
OCT: optical coherence tomography, MS: multiple sclerosis, PSS: Primary Sjögren's syndrome, HCs: healthy controls, SD: standard deviation, RNFL: retinal nerve fiber layer, GCC: ganglion cell complex, FV: fovea volume. p1: MS vs SS p2: MS vs controls

Table-4: Comparison of OCT measurements of MS participants and PSS participants with CNS involvement.
	MS (n = 60)			PSS with CNSL (n = 14)			p
Thickness, mean ± SD
RNFL, µm	88.8	±	12.5	93.1	±	11.9	0.265
inferior	100.5	±	19.0	105.9	±	22.9	0.233
superior	101.9	±	17.7	109.1	±	18.1	0.155
nasal	76.6	±	20.4	72.1	±	9.2	0.628
temporal	63.7	±	14.6	70.3	±	9.5	0.106
GCC, µm	85.8	±	14.4	90.9	±	6.2	0.106
superior	85.1	±	13.5	89.7	±	5.6	0.165
inferior	86.5	±	15.7	92.0	±	7.0	0.077
Fovea, µm	244.7	±	19.1	255.4	±	35.9	0.537
Parafovea, µm
inferior	305.3	±	39.0	318.9	±	41.6	0.077
superior	300.1	±	37.5	322.9	±	40.6	0.031^*
nasal	299.2	±	23.1	318.2	±	25.7	0.017^*
temporal	291.2	±	23.5	311.6	±	22.9	0.012^*
Perifovea, µm
inferior	270.5	±	21.9	286.5	±	38.5	0.098
superior	278.4	±	19.4	297.7	±	47.1	0.253
nasal	287.1	±	26.2	298.7	±	27.9	0.075
temporal	271.0	±	25.8	278.2	±	15.7	0.101
FV, mm³, mean ± SD	6.95	±	0.51	7.27	±	0.63	0.097
OCT: optical coherence tomography, pr: parameters, MS: multiple sclerosis, PSS: Primary Sjögren's syndrome, CNSL: central nervous system lesion, SD: standard deviation, RNFL: retinal nerve fiber layer, GCC: ganglion cell complex, FV: fovea volume, ^*p < 0.05.

Table-5: Comparison of OCT measurements between MS participants with and without optic neuritis and participants with Primary Sjögren's syndrome with central nervous system lesion.
	MS						PSS with CNSI (n = 14)			p1	^‡p2	^‡p3	^‡p4
	ON- (n = 30)			ON+ (n = 30)			PSS with CNSI (n = 14)			p1	^‡p2	^‡p3	^‡p4
Thickness, mean ± SD
RNFL, µm	90.7	±	13.6	86.8	±	11.1	93.1	±	11.9	0.239	0.440	0.258	0.818
inferior	102.8	±	21.9	98.2	±	15.4	105.9	±	22.9	0.441	0.639	0.454	0.879
superior	103.6	±	20.0	100.1	±	15.2	109.1	±	18.1	0.304	0.724	0.274	0.616
nasal	80.0	±	20.0	73.2	±	20.7	72.1	±	9.2	0.289	0.360	0.982	0.406
temporal	65.8	±	16.1	61.6	±	12.9	70.3	±	9.5	0.144	0.468	0.133	0.583
GCC, µm	88.4	±	16.4	83.2	±	11.7	90.9	±	6.2	0.144	0.287	0.176	0.827
superior	87.6	±	14.9	82.6	±	11.6	89.7	±	5.6	0.142	0.263	0.185	0.863
inferior	89.1	±	18.2	83.8	±	12.3	92.0	±	7.0	0.165	0.333	0.192	0.811
Fovea, µm	250.3	±	17.9	238.9	±	18.7	255.4	±	35.9	0.051	0.139	0.073	0.768
Parafovea, µm
inferior	277.3	±	23.8	263.4	±	17.6	286.5	±	38.5	0.014	0.093	0.017	0.499
superior	282.0	±	20.1	274.6	±	18.2	297.7	±	47.1	0.034	0.538	0.026	0.172
nasal	295.9	±	28.5	278.0	±	20.4	298.7	±	27.9	0.011	0.024	0.039	0.936
temporal	278.5	±	25.9	263.3	±	23.7	278.2	±	15.7	0.032	0.040	0.132	0.999
Perifovea, µm
inferior	317.0	±	47.4	293.2	±	22.9	318.9	±	41.6	0.033	0.051	0.104	0.986
superior	310.5	±	25.9	289.3	±	44.5	322.9	±	40.6	0.014	0.080	0.019	0.561
nasal	307.3	±	22.8	290.9	±	20.6	318.2	±	25.7	0.001	0.018	0.001	0.296
temporal	299.4	±	19.6	282.8	±	24.6	311.6	±	22.9	0.000	0.016	0.001	0.216
FV, mm³, mean ± SD	7.1	±	0.4	6.8	±	0.5	7.3	±	0.6	0.011	0.061	0.017	0.590
OCT: optical coherence tomography, MS: multiple sclerosis, ON: optic neuritis, PSS: Primary Sjögren's syndrome, CNSI: central nervous system involvement ^‡post hoc analysis, SD: standard deviation, RNFL: retinal nerve fiber layer, GCC: ganglion cell complex, FV: foveal volume P1: MS/ON- vs MS/ON + vs PSS p2: MS/ON- vs MS/ON+ P3: MS/ON + vs PSS P4: MS/ON- vs PSS

The authors declare no competing interests.

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Optical coherence tomography findings in multiple sclerosis and comparison with Primary Sjögren’s syndrome

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Abstract

Background

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INTRODUCTION

METHODS

Study design and participants

Inclusion and exclusion criteria

Study procedures

Initial evaluation

Optical coherence tomography

Statistical analysis

RESULTS

Characteristics of the participants

Optical coherence tomography parameters

Comparison of MS participants with PSS participants and healthy individuals

Comparison of MS participants and PSS participants with CNS involvement

DISCUSSION

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References

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