Çocuk Çölyak Hastalarında Laboratuvar Parametrelerinin Göz Yaşı Testleri ve Optik Koherens Tomografi Bulguları Üzerindeki Etkisi

Abstract

Amaç: Bu çalışmanın amacı çölyak hastalığı (ÇH) olan çocuklarda gözyaşı parametreleri ve optik koherens tomografi (OKT) bulgularını değerlendirmek ve bu bulgular ile laboratuvar verileri arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Çalışmaya ÇH nedeniyle takip edilen 50 hastanın 100 gözü ile herhangi bir oküler patolojisi olmayan 55 sağlıklı katılımcının 110 gözü dahil edildi. Tüm katılımcıların en iyi düzeltilmiş görme keskinliği değerlendirildi, standart Schirmer testi kullanılarak gözyaşı miktarı belirlendi ve floresein ile gözyaşı kırılma zamanı (GKZ) belirlendi. Pupiller dilatasyon sağlandıktan sonra maküla kesitleri ve optik disk kesitleri OKT cihazı ile alındı. Bulgular: Yaş ve cinsiyet dağılımı bakımından hasta ve kontrol grupları arasında istatistiksel olarak anlamlı farklılık yoktu (sırasıyla, p=0,490 ve p=0,930). Ortalama Schirmer testi değeri kontrol grubu ile karşılaştırıldığında ÇH hastalarında anlamlı olarak daha düşüktü (14,07±5,14 mm’ye karşı 20,20±3,93 mm, p<0,001). Ayrıca GKZ değeri sağlıklı katılımcılar ile karşılaştırıldığında ÇH hastalarında anlamlı olarak daha kısaydı (10,86±3,51 s’ye karşı 15,25±2,49 s, p<0,001). Ortalama total retina kalınlığı ve dış retina kalınlığı değerleri hasta grubunda kontrol grubuna göre anlamlı olarak daha düşüktü (her iki parametre için p<0,001). Ayrıca, ortalama retina sinir lifi (ORSL) kalınlığı kontrol grubu ile karşılaştırıldığında hasta grubunda anlamlı olarak daha inceydi (p<0,001). Sonuç: Sunulan bu çalışmada ÇH olan çocuklarda maküla ve ORSL kalınlığının kontrol grubuna göre azaldığı ve gözyaşı testlerinin de bozulduğu görülmüştür.

Keywords

• Çölyak hastalığı
• laboratuar parametreleri
• gözyaşı filmi
• optik koherens tomografi
• çocuk hastalar

Effects of Laboratory Parameters on Tear Tests and Optical Coherence Tomography Findings in Pediatric Celiac Disease

Abstract

Aim: The aim of this study was to evaluate the tear parameters and optical coherence tomography (OCT) findings in children with celiac disease (CD) and to investigate the relationship between these findings and laboratory data. Material and Methods: The study included 100 eyes of 50 CD patients as well as 110 eyes of 55 healthy subjects with no ocular pathology as a control group. Best corrected visual acuity was evaluated, baseline tear volume was estimated using standard Schirmer’s test, and fluorescein tear film break-up time (TBUT) was determined for all participants. Pupillary dilation was induced and macular sections and optic disc sections were obtained with OCT. Results: The patient and control groups showed no statistically significant differences in terms of age and gender distribution (p=0.490, and p=0.930, respectively). Mean Schirmer’s test measurement was significantly lower in the CD patients compared to the control group (14.07±5.14 mm vs. 20.20±3.93 mm, p<0.001). TBUT was also shorter in the CD patients compared to the control subjects (10.86±3.51 s vs. 15.25±2.49 s, p<0.001). Mean total retinal thickness and outer retinal thickness values were significantly lower in the patient group than in the control group (p<0.001, for both parameters). In addition, the mean retinal nerve fiber layer (RNFL) thickness measurement was significantly thinner in the patient group than in the control group (p<0.001). Conclusion: In the presented study, it was observed that macular and RNFL thickness were decreased in children with CD compared to the control group, and tear tests were also impaired.

Keywords

• Celiac disease
• laboratory parameters
• tear film
• optical coherence tomography
• pediatric patients

References

1. Jimenez J, Loveridge-Lenza B, Horvath K. Celiac disease in children. Pediatr Clin North Am. 2021;68(6):1205-19.
2. Cabanillas B. Gluten-related disorders: Celiac disease, wheat allergy, and nonceliac gluten sensitivity. Crit Rev Food Sci Nutr. 2020;60(15):2606-21.
3. Dicke WK, Weijers HA, van de Kamer JH. Coeliac disease. II. The presence in wheat of a factor having a deleterious effect in cases of coeliac disease. Acta Paediatr (Stockh). 1953;42(1):34-42.
4. Trancone R, Jabri B. Celiac disease and gluten sensitivity. J Intern Med. 2011;269(6):582-90.
5. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107(10):1538-44.
6. Dalgic B, Sari S, Basturk B, Ensari A, Egritas O, Bukulmaz A, et al. Turkish Celiac Study Group. Prevalance of celiac disease in healthy Turkish school children. Am J Gastroenterol. 2011;106(8):1512-7.
7. Parzanese I, Qehajaj D, Patrinicola F, Aralica M, Chiriva-Internati M, Stifter S, et al. Celiac disease: From pathophysiology to treatment. World J Gastrointest Pathophysiol. 2017;8(2):27-38.
8. Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease. Am J Med. 2006;119(4):355.e9-14.

9. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43-52.
10. Durazzo M, Ferro A, Brascugli I, Mattivi S, Fagoonee S, Pellicano R. Extra-intestinal manifestations of celiac disease: What should we know in 2022? J Clin Med. 2022;11(1):258.
11. Whyte LA, Jenkins HR. The epidemiology of coeliac disease in South Wales: A 28-year perspective. Arch Dis Child. 2013;98(6):405-7.
12. Fousekis FS, Katsanos A, Katsanos KH, Christodoulou DK. Ocular manifestations in celiac disease: an overview. Int Ophthalmol. 2020;40(4):1049-54.
13. Karatepe Hashas AS, Altunel O, Sevinc E, Duru N, Alabay B, Torun YA. The eyes of children with celiac diease. J AAPOS. 2017;21(1):48-51.
14. Uzel MM, Citirik M, Kekilli M, Cicek P. Local ocular surface parameters in patients with systemic celiac disease. Eye (Lond). 2017;31(7):1093-8.
15. Jin KW, Ro JW, Shin YJ, Hyon JY, Wee WR, Park SG. Correlation of vitamin D levels with tear film stability and secretion in patients with dry eye syndrome. Acta Ophthalmol. 2017;95(3):e230-5.
16. Rathnajumar K, Ramachandran K, Baba D, Ramesh V, Anebaracy V, Vidhya R, et al. Prevalence of dry eye disease and its association with dyslipidemia. J Basic Clin Physiol Pharmacol. 2018;29(2):195-9.
17. Aksoy A, Aslan L, Aslankurt M, Eser O, Garipardic M, Okumuş S, et al. Retinal fiber layer thickness in children with thalessemia major and iron deficiency anemia. Semin Ophthalmol. 2014;29(1):22-6.
18. Türkyılmaz K, Öner V, Türkyılmaz AK, Kırbaş A, Kırbaş S, Şekeryapan B. Evaluation of peripapillary nevre fiber layer thickness in patients with vitamin B12 deficiency using spectral domain optical coherence tomography. Curr Eye Res. 2013;38(6):680-4.
19. Larner AJ. Visual failure caused by vitamin B12 deficiency optic neuropathy. Int J Clin Pract. 2004;58(10):977-8.
20. Graffe A, Beauchet O, Fantino B, Milea D, Annweiler C. Vitamin D and macular thickness in the elderly: an optical coherence tomography study. Invest Ophthalmol Vis Sci. 2014;55(8):5298-303.
21. Uro M, Beauchet O, Cherif M, Graffe A, Milea D, Annweiler C. Age-related vitamin D deficiency is associated with reduced macular ganglion cell complex: a cross-sectional high-definition optical coherence tomography study. PLoS One. 2015;10(6):e0130879.
22. Benarous R, Sasongko MB, Qureshi S, Fenwick E, Dirani M, Wong TY, et al. Differential association of serum lipids with diabetic retinopathy and diabetic macular edema. Invest Ophthalmol Vis Sci. 2011;52(10):7464-9.
23. Davoudi S, Papavasileiou E, Roohipoor R, Cho H, Kudrimoti S, Hancock H, et al. Optical cohrence tomography characteristics of macular edema and hard exudates and their association with lipid serum levels in type 2 diabetes. Retina. 2016;36(9):1622-9.
24. Sasaki M, Kawashima M, Kawasaki R, Uchida A, Koto T, Shinoda H, et al. Association of serum lipids with macular thickness and volume in type 2 diabetes without diabetic macular edema. Invest Ophthalmol Vis Sci. 2014;55(3):1749-53.
25. Kardys A, Weinstock-Guttman B, Dillon M, Masud MW, Weinstock N, Mahfooz N, et al. Cholesterol affects retinal nevre fiber layer thickness in patients with multiple sclerosis with optic neuritis. Eur J Neurol. 2013;20(9):1264-71.
26. Stenbes WE. The lipid hypothesis and the role hemodynamics in atherogenesis. Prog Cardiovacs Dib. 1990;33(2):119-36.