Ocular parameters quantified by the swept-source optical coherence tomography in celiac disease

327 CMJ Original Research September 2020, Volume: 42, Number: 3 Cumhuriyet Tıp Dergisi (Cumhuriyet Medical Journal) 327-333 http://dx.doi.org/10.7197/cmj.vi.780554 Ocular parameters quantified by the swept-source optical coherence tomography in celiac disease Çölyak hastalığında swept-source optik tomografi ile ölçülen oküler parametreler koherens Arif Ülkü Yener1, Muhammet Yener Akpınar2, Evrim Karamanoğlu2, Ferdane Pirinçci Sapmaz2, Yaşar Nazlıgül2 Department of Ophthalmology, Keçiören Training and Research Hospital, Ankara, Turkey Department of Gastroenterology, Keçiören Training and Research Hospital, Ankara, Turkey Corresponding author: Arif Ülkü Yener, MD, Department of Ophthalmology, Keçiören Training and Research Hospital, Ankara, Turkey E-mail: Received/Accepted: August 14, 2020 /September 21, 2020 Conflict of interest: There is not a conflict of interest. 1 2 SUMMARY Objective: To measure anterior and posterior segmental ocular parameters in patients with celiac disease using swept-source optical coherence tomography and compare with those of healthy subjects. Method: Fourteen patients with celiac disease referred from the gastroenterology clinic and 14 control subjects selected from the individuals with minor complaints who admitted the ophthalmology outpatient clinic were included in the study. Mean and segmental retinal nerve fiber layer thickness in four quadrant, average and sectoral ganglion cell inner plexiform layer thickness in six quadrant, foveal and parafoveal vessel density in four quadrant, optic nerve head parameters, including rim area, disc area, horizontal cup-to-disc ratio, vertical cup-to-disc ratio, cup volume, and additionally superficial/deep foveal avascular zone areas, choroidal thickness, and central corneal thickness of patients and controls were quantified using swept-source optical coherence tomography. Results: Among all the measurements, retinal nerve fiber layer in nasal quadrant and subfoveal choroid of patients were significantly thicker than those of controls. Nasal quadrant retinal nerve fiber layer thickness for patients and controls were 91.62±15.27 µm and 79.93±10.43 µm, respectively (P=0.02). Choroidal thickness was 377.69±50.77 µm for patients and 310.93±95.13 µm for controls (P=0.03). Conclusions: Even though celiac disease is primarily a disease of small intestine, this study demonstrated that the disorder can affect the eye as an extra intestinal involvement. Keywords: Celiac disease; optical coherence tomography; choroidal thickness; retinal nerve fiber layer thickness Arif Ülkü Yener Muhammet Yener Akpınar Evrim Karamanoğlu Ferdane Pirinçci Sapmaz Yaşar Nazlıgül ORCID IDs of the authors: A.Ü.Y. 0000-0002-0039-0438 M.Y.A. 0000-0003-0903-4664 E.K. 0000-0001-8887-3428 F.P.S. 0000-0003-1278-110X Y.N. 0000-0003-1926-4594 ÖZET Amaç: Çölyak hastalarında swept-source optik koherens tomografi kullanarak ön ve arka segment göz parametrelerini ölçmek ve bunları sağlıklı kişilerinkilerle karşılaştırmak. Yöntem: Gastroenteroloji kliniğinden sevk edilen 14 çölyak hastası ve ufak şikayetlerle göz polikliniğine müracaat eden hastalardan seçilen 14 sağlıklı kontrol çalışma kapsamına alındı. Hastaların ve kontrol grubunun ortalama ve dört kadranda retina sinir lifi tabakası kalınlığı, ortalama ve altı kadranda gangliyon hücre iç pleksiform tabakası kalınlığı, foveal ve fovea çevresi 4 kadranda damar yoğunluğu; rim alanı, disk alanı, yatay çukurluk/disk oranı, dikey çukurluk/disk 328 oranı ve çukurluk hacmı gibi optik sinir başı parametreleri ve ayrıca yüzeysel/derin foveal damarsız bölge alanı, koroid kalınlığı ve merkezi kornea kalınlığı swept-source optik koherens tomografi cihazı yardımıyla ölçüldü. Bulgular: Bütün ölçüm sonuçları arasında hastalardaki nasal kadran retina sinir lifi ve fovea altı koroid kontrol grubundan anlamlı derecede daha kalındı. Hastaların ve kontrollerin nasal kadran retina sinir lifi tabakası kalınlığı sırasıyla 91.62±15.27 µm ve 79.93±10.43 µm idi (P=0.02). Hastalar için koroid kalınlığı 377.69±50.77 µm, kontroller için 310.93±95 µm idi (P=0.03). Sonuç: Çölyak, öncelikli olarak bir ince bağırsak hastalığı olsa da bu çalışma hastalığın bağırsak dışı bir tutulum yeri olarak gözü de etkileyebileceğini göstermiştir. Anahtar sözcükler: Çölyak hastalığı, optik koherens tomografi, koroid kalınlığı, retina sinir lifi tabakası kalınlığı. INTRODUCTION Celiac disease (CD) is a gluten sensitive autoimmune disorder of small intestine that affects genetically predisposed individuals. Diarrhea, steatorrhea and malabsorption are the gastrointestinal originated classical symptoms. Half of the CD patients presents extraintestinal findings, such as anemia, osteoporosis, dermatitis and neurological problems 1-3. The clinical appearance of CD is related to having genetic and immunological factors with age of onset, extent of mucosal deterioration, dietary habits and sex 4. CD is essentially diagnosed by the presence of predisposing genetic factor of human leukocyte antigen (HLA), positive biopsy and serological antibodies upon the diet with gluten. CD may present in different forms 5.The classical form may occur at any age of life and is often characterized by crypt hyperplasia and villous atrophy. The atypical form is characterized by positive serology, limited abnormalities of small intestinal mucosa, but associated with extra intestinal manifestations, including osteoporosis, neuropathy and anemia. The latent form is defined by the presence of predisposing gene HLD-Q2 and HLD-Q8, normal intestinal mucosa and possible positive serology. In refractory form, usually after age 50 years, some patients initially respond to a gluten free diet and develop recurrent symptoms. Gliadin peptides strongly bind to HLA, especially HLD-Q2 and HLD-Q8, expressed on antigenpresenting cells. Since gliadin peptides are resistant to gastrointestinal enzymes, they cause an inflammatory reaction that results in damage to intestinal mucosa and affect permeability 6-10. CD is triggered by the ingestion of gliadin and other related prolamins in genetically susceptible subjects. Wheat, barley and rye induce CD 11-13. Although the diagnosis of CD can be made based on clinical and laboratory clues, histology of the proximal small intestinal mucosa is stil the diagnostic gold standard and must always be performed. Marsh and Oberhuer classified the histopathology of intestinal mucosa in CD patients as 6-stage grading 14,15. The aim of this study was to demonstrate whether the celiac disease affects the eye as a systemic autoimmune inflammatory disorder. MATERIAL AND METHODS Subjects Patients with CD and controls were recruited in the study in accordance with the tenets of Declaration of Helsinki and written consents were obtained from all of the patients and controls. The study protocol was reviewed and approved by the Ethic Committee of Hospital before starting to study. Patients were between 20 and 62, control subjects were between (...truncated)