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

Purpose: 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. Methods: This was a retrospective study. Demographic, clinical and imaging data were collected. Results: 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. Conclusion: 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.