Choroidal thickness and retinal nerve fiber layer analysis in chronic spontaneous urticaria

Abstract

Aim: In this study, we investigated the effects of chronic spontaneous urticaria on the choroid and retinal nerve fiber layer. Material and Method: The patient group consisted of newly diagnosed 54 chronic spontaneous urticaria (CSU ) patient and the control group consisted of 54 healthy volunteer. Choroidal and retinal nerve fiber layer (RNFL) thickness measurements were performed with Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) 30 minutes after pupil dilation with 0,5% tropicamide. Results: In the patient group, nasal choroidal thickness (NCT) was 290.11±43.16 μm, subfoveal choroidal thickness (SFCT) was 339.17±37.709 μm, temporal choroidal thickness (TCT) was 296.00±42.859 μm, mean choroidal thickness (MCT) was 308.33±35.923 μm and RNFL thickness was 91.11±7.393 μm. NCT was 248.42±35,742 μm, SFCT 276.56±40.04 μm, TCT 253.69±37.384 μm, MCT 259.50±32,986 μm and RNFL thickness 92.19±8.719 μm in the control group. When we examine the p value, it is seen that both groups are similar to each other in terms of RNFL thickness (p=0.326), while there is a significant thickening in all choroidal regions of patients with CSU, including NCT, SFCT, TCT, MCT (p=0.000, p=0.000, p=0.000, p=0.000, respectively). Conclusion: The choroid is affected in CSU and choroidal thickness can be a noninvasive method that can be used in diagnosis CSU. However, studies of longer disease durations may provide more illuminating information about CSU and choroid and RNFL.

Keywords

• Choroidal thickness
• chronic spontaneous urticaria
• EDI-OCT
• histamine
• retinal nerve fiber layer

References

1. Alizadeh Aghdam M, van den Elzen M, van Os-Medendorp H, et al. Systemic and local evidence for complement involvement in chronic spontaneous urticaria. Clin Transl Allergy 2021; 11: 2011.
2. Saini SS, Kaplan AP. Chronic Spontaneous Urticaria: The Devil's Itch. J Allergy Clin Immunol Pract 2018; 6: 1097-6.
3. Kaplan AP, Horáková Z, Katz SI. Assessment of tissue fluid histamine levels in patients with urticaria. J Allergy Clin Immunol 1978; 61: 350-4.
4. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res 2010; 29: 144-68.
5. Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S. Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: A review. Surv Ophthalmol 2019; 64: 757-69.
6. Demirkan S, Onaran Z, Samav G, et al. Decreased choroidal thickness in vitiligo patients. BMC Ophthalmol 2018; 18: 126.
7. Şahin T, Öztekin A, Cevher S. Does Rosacea, a localized skin disease, affect the choroidal thickness? J Cosmet Dermatol 2022; 21: 387-1.
8. Ataş M, Yuvacı I, Demircan S, et al. Evaluation of the macular, peripapillary nerve fiber layer and choroid thickness changes in Behçet's disease with spectral-domain OCT. J Ophthalmol 2014; 2014: 865394.

9. Lim HB, Sung JY, Ahn SI, Jo YJ, Kim JY. Retinal nerve fiber layer thickness in various retinal diseases. Optom Vis Sci 2018; 95: 247-5.
10. Yılmaz M, Polat OA, Karayiğit DZ, Ayyıldız T. Choroidal vascularity index and choroidal thickness changes in patients with allergic asthma. Photodiagnosis Photodyn Ther 2021; 36:102494.
11. Ornek N, Onaran Z, Koçak M, Ornek K. Retinal nerve fiber layer thickness in vitiligo patients. J Res Med Sci 2013; 18: 405-7.
12. Chee SP, Afrin M, Tumulak MJ, Siak J. Role of optical coherence tomography in the prognosis of Vogt-Koyanagi-Harada disease. Ocul Immunol Inflamm 2021; 29: 118-3.
13. Asero R, Tedeschi A, Marzano AV, Cugno M. Chronic urticaria: a focus on pathogenesis. F1000Res 2017; 6: 1095.
14. Trinh HK, Pham DL, Ban GY, Lee HY, Park HS, Ye YM. Altered systemic adipokines in patients with chronic urticaria. Int Arch Allergy Immunol 2016; 171: 102-10.
15. Fraser K, Robertson L.Chronic urticaria and autoimmunity. Skin Therapy Lett 2013; 18: 5-9.
16. Asero R, Tedeschi A, Riboldi P, Cugno M. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum. J Allergy Clin Immunol 2006; 117: 1113-7.
17. Kocatürk E, Grattan C. Is chronic urticaria more than skin deep? Clin Transl Allergy 2019; 9: 48.
18. Son JH, Chung BY, Kim HO, Park CW. A histamine-free diet is helpful for treatment of adult patients with chronic spontaneous urticaria. Ann Dermatol 2018; 30: 164-2.
19. Weigert G, Zawinka C, Resch H, Schmetterer L, Garhöfer G. Intravenous administration of diphenhydramine reduces histamine-induced vasodilator effects in the retina and choroid. Invest Ophthalmol Vis Sci 2006; 47: 1096-100.
20. Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S. Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: A review. Surv Ophthalmol 2019; 64: 757-69.
21. Wang Y, Fang JL, Cui B, et al. The functional and structural alterations of the striatum in chronic spontaneous urticaria. Sci Rep 2018; 8: 1725.
22. Fumal A, Crémers J, Ambrosini A, Grand JL, Schoenen J. Migraine with urticaria. Neurology 2006; 67: 682.
23. Harada T, Yamamura Y, Ishizaki F, et al. A case of cholinergic urticaria with epileptic seizure and abnormalities on electroencephalogram. No To Shinkei 2001; 53: 863–8.
24. Nowak JZ, Nawrocki J. Histamine in the human eye. Ophthalmic Res 1987; 19: 72-5.
25. Rogosić V, Bojić L, Puizina-Ivić N, et al. Vitiligo and glaucoma - an association or a coincidence? A pilot study. Acta Dermatovenerol Croat. 2010; 18: 21-6.