Implications of peripapillary retinal nerve fiber layer thickening by optical coherence tomography in children with pars planitis

TL;DR

This study found that thickening of the retinal nerve fiber layer in children with pars planitis is linked to disease severity and treatment needs, and it can help monitor treatment response over time.

Contribution

This is the first longitudinal study to investigate OCT-RNFLT in pediatric pars planitis patients.

Findings

OCT-RNFLT ≥130 µm was significantly associated with higher disease severity and more intensive immunosuppressive treatment.

Improvement in disease activity preceded changes in OCT-RNFLT, suggesting its potential as a monitoring tool.

Papillitis was significantly linked to higher RNFL values, while anterior uveitis was not.

Abstract

To assess retinal nerve fiber layer thickness by optical coherence tomography (OCT-RNFLT) in children with pars planitis and to examine its associations with visual acuity, binocular indirect ophthalmoscopy score (BIO), ocular signs and medical therapies.

This was a retrospective study. Demographic, clinical and imaging data were collected.

Included were 29 children (50 eyes) with a mean age of 7.9 ± 2.9 years. Presenting OCT-RNFLT (28 eyes) was 209.6 ± 179 μm. Twenty-two eyes (78.6%) had OCT-RNFLT ≥ 130 μm and it was significantly associated with higher BIO score (2.02 ± 1.21 vs. 0.42 ± 0.80 in eyes with OCT-RNFLT < 130 μm), anterior uveitis, papillitis, conventional disease-modifying antirheumatic drugs and biologic therapy. Following the initiation of therapy, improvement in BIO score was observed promptly, preceding the improvement in OCT-RNFLT. In the univariate general linear model, BIO group classification demonstrated the strongest association with RNFLT (F = 16.69, p < 0.001). Papillitis was also significantly associated with higher RNFL values (F = 6.47, p = 0.015). Anterior uveitis did not show a significant association with RNFLT (F = 0.02, p = 0.883), suggesting that posterior segment findings could be more relevant indicators of RNFLT in this cohort.

To date, this is the first longitudinal study that investigated OCT-RNFLT in pediatric pars planitis patients. OCT-RNFLT strongly correlated with disease severity and eyes with OCT-RNFLT ≥130 µm required at a higher rate the institution of intensive immunosuppressive regimen. The reduction in OCT-RNFLT with resolving inflammation highlights its potential role as a tool for monitoring therapeutic response over time.

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