4 | DISCUSSION
This is the first pediatric research studying CT at three different
areas of choroid in order to evaluate the immunopathologic processes
within choroid in pediatric CD patients reflecting eye involvement in
this autoimmune disease by the help of EDI-OCT. There are studies in
literature with different results; Bölükbaşı et al. found an increase in
adult CD patients at seven areas (one subfoveal, three nasal, three
temporal)15, but Doğan et al. found an insignificant
decrease at subfoveal area in pediatric CD patients at gluten free diet
for 5 years.16
According to our study results in pediatric CD patients who made gluten
free diet for one year after endoscopic diagnosis, CT were thinner at
all subfoveal, nasal and temporal points compared to control group. Our
findings were supporting the study results of Dogan. Although they made
the CT measuements at only one point at subfoveal area, in our study, CT
measurements were made at three different points of choroid. Baltmr A et
al. reported that, in the acute inflammatory phase, CT usually
increases, while atrophic changes in recurrent inflammatory conditions
result in decreased CT in local ocular inflammation.24Tekin et al. found a significant decrease in CT in pediatric
malnutrition cases.25 Our findings may be reflecting
that the immunopathologic changes in choroid did not recover with gluten
free diet since intestinal mucosa recovery is incomplete at one year or
may be reflecting atrophic changes in CT without recovery with gluten
free diet or may be due to effect of malnutrition and malabsorbtion of
vitamin A and D. There is a need for follow up studies measuring CT at
diagnosis time and after gluten free diet in follow-up period.
Early and initial signs of systemic and autoimmune diseases can also be
evaluated by measuring the thickness of GCC complex composed of; RNFL,
GCL and IPL of optic nerve by the help of
EDI-OCT.8,9,10,11 Our measurement results of GCC layer
thicknesses (Five points of RNFL, GCL and IPL) revealed similar results
in CD and control groups. There are papers reporting decreased
thicknesses of these layers in Behçet’s disease, SLE, MS and obesity
patients due to effects of autoinflammatory diseases and metabolic
stress.11,14,19,20 There is only one adult CD study by
Hazar et al. reporting that superior and nasal RNFL was
decreased.22 There is only one pediatric CD study by
Hashas, reporting a decrease in global, temporal, superior temporal and
superior nasal RNFL.23
GCC is a continuation of optic nerve. In our study we did not found a
decrease in thicknesses of GCC layers which may reflect neural tissue
involvement is a more complicated issue.12 Study by
Hazar et al was in adults and study by Hashas in pediatric were with a
small number study.21,23 Their theory accepts that the
immune antibodies would be causing that decrease in RNFL, GCL and IPL,
but these layers are not in direct contact with these antibodies. There
are Behçet’s disase, SLE and MS studies reporting decreased thicknesses
of GCC layers, which inflammatory effects of these diseases are directly
influencing neural tissue.11,14,20 But antibodies
causing Celiac disease
In conclusion, our study shows that Pediatric CD causing thinning of
subfoveal, nasal and temporal areas of choroid, and this change is
apparent even after one year gluten free diet as an extraintestinal
finding. This finding may be a new form of nonclassical presentation of
CD. Thickneses of GCC layers were similar in CD and control groups may
be revealing the effect of diet or these layers are not involved in CD
eye findings pathogenesis. Eye findings as an extraintestinal
involvement should be more closely screened at diagnosis and longterm
clinical results of thin choroid and GCC should be determined in
pediatric CD.