The Role of the Retinal Nerve Fiber Layer Thickness on OCT in the Evaluation of Papillitis in Childhood Uveitis.
Kouwenberg Carlyn V, Blom Laurens A, Vellinga Suzanne C, Bozkir Irem, de Boer Joke H, Ayuso Viera Koopman-Kalinina
AI Summary
OCT-RNFL thickness >130 µm is a useful, non-invasive diagnostic marker for papillitis in pediatric uveitis, showing good sensitivity/specificity and correlating with active disease and macular edema.
Abstract
Purpose
To investigate the diagnostic value of using retinal nerve fiber layer thickness measured on optical coherence tomography (OCT-RNFL) to diagnose papillitis in pediatric uveitis.
Design
Retrospective cohort study.
Methods
Demographic and clinical data were collected retrospectively for 257 children with uveitis (with 455 affected eyes). Receiver operating characteristic (ROC) analysis was performed to compare fluorescein angiography (FA, the diagnostic gold standard for papillitis) to OCT-RNFL in a subgroup of 93 patients. An ideal cut-off value for OCT-RNFL was then determined by calculating the highest Youden index. Finally, a multivariate analysis was applied to the clinical ophthalmological data.
Results
Based on a subset of 93 patients who underwent both OCT-RNFL and FA, the ideal cut-off OCT-RNFL for diagnosing papillitis was >130 µm, with 79% sensitivity and 85% specificity. Among the entire cohort, the prevalence of OCT-RNFL >130 µm was 19% (27/141), 72% (26/36), and 45% (36/80) in patients with anterior uveitis, intermediate uveitis, and panuveitis, respectively. Our multivariate analysis of the clinical data revealed that OCT-RNFL >130 µm was associated with a higher prevalence of cystoid macular edema, active uveitis, and optic disc swelling on fundoscopy, with odds ratios of 5.3, 4.3, and 13.7, respectively (all P < .001).
Conclusions
OCT-RNFL can be a useful noninvasive additional imaging tool for diagnosing papillitis in pediatric uveitis with relatively high sensitivity and specificity. OCT-RNFL was >130 µm in approximately one-third of all children with uveitis and was particularly prevalent in cases of intermediate uveitis and panuveitis.
MeSH Terms
Shields Classification
Key Concepts4
The ideal cut-off retinal nerve fiber layer thickness (OCT-RNFL) for diagnosing papillitis in pediatric uveitis was >130 µm, demonstrating 79% sensitivity and 85% specificity, based on a subset of 93 patients who underwent both OCT-RNFL and fluorescein angiography (FA).
Among the entire cohort of children with uveitis, the prevalence of OCT-RNFL >130 µm was 19% (27/141) in patients with anterior uveitis, 72% (26/36) in intermediate uveitis, and 45% (36/80) in panuveitis.
In children with uveitis, OCT-RNFL >130 µm was associated with a higher prevalence of cystoid macular edema (odds ratio 5.3, P < .001), active uveitis (odds ratio 4.3, P < .001), and optic disc swelling on fundoscopy (odds ratio 13.7, P < .001) in a multivariate analysis of clinical data.
Optical coherence tomography retinal nerve fiber layer thickness (OCT-RNFL) can serve as a useful noninvasive additional imaging tool for diagnosing papillitis in pediatric uveitis, demonstrating relatively high sensitivity and specificity.
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