Retinal vascular density evaluation of migraine patients with and without aura and association with white matter hyperintensities

DOI: https://doi.org/10.1007/s13760- 019- 01094- 7

Abstract-Summary We aimed to evaluate the retinal vessel densities of migraine patients with and with- out aura and the associations with white matter hyperintensities (WMH), using opti- cal coherence tomography angiography (OCTA).

We recruited 28 migraine with aura (MWA) patients, 26 migraine without aura

(MWO) and age and sex-matched 34 healthy controls in our study.

All participants were evaluated with optical coherence tomography (OCT) and OCTA for optic nerve parameters and retinal vessel densities with RTVue XR AVANTI.

On macular OCTA, superficial and deeper retinal foveal vessel density (VD)

were significantly lesser in MWA and MWO than controls.

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3 Diagnosis

On optic nerve OCTA, whole optic disc, peripapillary, superior hemisphere, superior layer and temporal layer VD were significantly lesser in MWA and MWO. In group of MWA with the WMH, deeper foveal VD and superior hemisphere VD, average RNFL, superior hemisphere and superior layer were significantly lesser and also foveal avascular zone was significantly larger than the group of without WMH.

Extended: For more efficient use of OCTA we believe that further studies with

larger sample sizes and long-term follow-up would be useful.

Introduction The pathogenesis of migraine is still debated among researchers; however, it is sup- posed that migraine episodes lead to activation of the trigeminal vascular system (TGVS), which is responsible for regulating vascular tone and transmitting pain signals [469].

Retinal vascular occlusions have previously been reported in some migraine

patients [391, 392].

Brain white matter hyperintensities (WMHs) visualised using magnetic reso- nance imaging (MRI) have been described in migraine as well as in several other neurological disorders [470].

The purpose of the present study was to evaluate retinal vessel density and its

associations with WMHs in migraine patients using OCTA.

Materials and methods We have evaluated the brain magnetic resonance imaging scans which were retro- spectively studied of migraine patients for detecting the WMH.

RNFL, and GCC analyses were obtained by the same experienced technician using a high-speed, high-resolution spectral-domain OCT device (λ  =  840 nm, 26,000 A-scans/s, and 5 μm axial resolution), and results were analyzed using Optovue RTVue software version 3.5 (Optovue Inc., Fremont, CA, USA).

For RNFL analysis, “3D optic disc 4_4 mm protocol” scanning was performed. Report, we analyzed vessel density in the peripapillary RNFL in images with a

4.5 3 4.5-mm field of view centered on the optic disc.

Whole enface image vessel density (wiVD) was measured in the entire 4.5 3 4.5- mm image, and circumpapillary vessel density (cpVD) was calculated in the region defined as a 750-lm-wide elliptical annulus extending from the optic disc boundary.

Results The mean age of the MWA patients was 40.8  ±  12.5 years, MWO patients was 38.6 ± 13.5 years and that of the controls was 37.1 ± 11.1 years. (p = 0.38) The gender distribution in the MWA group was M/F: 8/20, in the MWO group was M/F: 7/19 and in the control group was M/F: 12/24. (p = 0.45) WMH was found 9/28 of WMA and 7/26 of WMO group.

In SD-OCT measurements, average RNFL, superior hemisphere, superior and temporal sector were significantly thinner in MWA and MWO groups than in con- trol group.

3.4 Neuroimaging

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Discussion Significant differences were found in macular and optic nerve OCTA measurements between the MWA and MWO groups and controls.

The authors reported that the superficial foveal VD and superior peripapillary VD of WMA patients were significantly lower than in MWO patients and healthy controls.

The association between WML and the retina was evaluated in two recent stud- ies; in one of these, the authors found that the RNFL thickness of the migraine patients with WMHs was thinner than that of those without WMHs and the control group [471].

Using macular OCTA, we found that deeper foveal VD and superior hemisphere VD were lower than in the MWA group without WMHs, indicating an association between WMHs and ischaemia.

In the first known study of migraine and RNFL thickness, Tan and others reported no statistically significant differences in RNFL measurements between migraineurs and healthy controls [401].

Acknowledgement A machine generated summary based on the work of Ulusoy, Mahmut Oğuz; Horasanlı, Bahriye; Kal, Ali. 2019 in Acta Neurologica Belgica.

Multimodal MRI-based classification of migraine: using deep learning convolutional neural network