Evaluation of eye involvement in paediatric celiac disease patients

Abstract

Background The non‐classic presentation of paediatric celiac disease (CeD) becomes increasingly common in daily practice, which requires an awareness of eye findings. The purpose of this study was to evaluate eye involvement and effect of gluten‐free diet on ocular involvement in paediatric CeD patients by measuring the thicknesses of choroid and ganglion cell complex (GCC) composed of retinal nerve fibre layer, ganglion cell layer and inner plexiform layer using enhanced depth imaging optical coherence tomography. Methods Forty‐three CeD patients aged between four and 16 years (mean age: 9.9 ± 4.1, 12 boys and 31 girls) and 48 healthy children (mean age: 11.3 ± 4.1,17 boys and 31 girls) were compared. Following comprehensive eye examinations, thicknesses of choroid at three points and GCC layers (retinal nerve fibre layer at five points, ganglion cell layer and inner plexiform layer) were obtained using enhanced depth imaging optical coherence tomography. Measurement of thicknesses of choroid and GCC layers by a trained optical coherence tomography technician and an ophthalmologist who were not aware about group of children in paediatric CeD patients with 1 year gluten‐free diet was carried out. Results All layers of subfoveal, nasal and temporal choroid were significantly thinner in CeD than in the control group (P < .001, all, respectively). No significant difference was observed between the CeD and control groups in terms of GCC thicknesses (P > .05, all, respectively). Conclusion Paediatric CeD caused thinning of subfoveal, nasal and temporal areas of choroid, and this change is apparent even after 1 year gluten‐free diet. This eye involvement should be more closely screened at diagnosis, and long‐term clinical results of thin choroid should be determined. Thicknesses of GCC layers were not different in CeD group and may reveal the effect of diet or not involvement.

Optical Coherence Tomography Analysis of Retinal Layers in Celiac Disease

“…Several explanations could be adduced to elucidate some differences between the previous studies [ 11 , 12 , 13 , 14 ] and the present one.…”

“…First, the current study utilized the largest sample size, which was determined using a power calculation assessment [ 21 ]. As a result, previous papers [ 11 , 12 , 13 , 14 ] may have yielded different results that contradicted one another due to small and insignificant sample sizes.…”

“…Furthermore, the present study examined just one eye per participant, whereas all prior studies [ 11 , 12 , 13 , 14 ] examined both eyes in some individuals and only one eye in others. According to McAlinden et al [ 24 , 25 ], this might lead to statistical bias, affecting the results.…”

“…Concerning the peripapillary RNFL, few previously published papers have addressed this issue without reaching any agreement in the results [ 11 , 12 , 13 , 14 ]. Our results confirmed, in adults, the findings obtained by Dereci et al [ 14 ], who, when evaluating both peripapillary RNFL and GCC in 86 eyes of 43 children, found no significant statistical differences between celiac children and healthy controls.…”

“…To the best of our knowledge, no studies have been published examining all the retinal layers concerning retinal involvement in celiac disease. Only a few studies evaluated the peripapillary retinal nerve fiber layer (RNFL), showing no consensus in children and adults [ 11 , 12 , 13 , 14 ]. In addition, one study also evaluated the ganglion cell complex (GCC) in a pediatric population, finding no statistical difference between celiac patients and healthy controls [ 14 ].…”