Retinal Changes in Pediatric Glaucoma and Nonglaucomatous Optic Atrophy

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Retinal Imaging

Background:

• Glaucoma and optic atrophy in children can present with complex retinal changes.
• Optical coherence tomography (OCT) is crucial for evaluating retinal structures in pediatric eye diseases.

Purpose of the Study:

• To determine the incidence and significance of retinal changes in pediatric eyes with glaucoma and nonglaucomatous optic atrophy using OCT.
• To differentiate retinal findings associated with specific pediatric optic neuropathies.

Main Methods:

• Retrospective observational case series of pediatric patients undergoing OCT.
• Included 227 eyes (151 glaucoma, 76 optic atrophy); excluded poor-quality scans and glaucoma suspects.
• Analyzed outer retinal changes and inner nuclear layer (INL) cysts, correlating findings with visual acuity and retinal nerve fiber layer (RNFL) thickness.

Main Results:

• Outer retinal changes were observed in 13.2% of glaucoma eyes and 7.9% of optic atrophy eyes, primarily linked to conditions directly affecting the retina.
• Isolated inner nuclear layer (INL) cysts were significantly more frequent in nonglaucomatous optic atrophy (30%) compared to glaucoma (4.6%) (P < .0001).
• Eyes with INL cysts exhibited thinner RNFL and worse visual acuity compared to those without (P < .0001 and P < .002, respectively).

Conclusions:

• Inner nuclear layer (INL) cysts are a notable finding in pediatric optic atrophy, associated with poorer visual outcomes and reduced RNFL thickness.
• Outer retinal changes in pediatric eyes suggest direct retinal pathology.
• The presence of INL cysts or outer retinal changes in children, without a history of intraocular surgery or uveitis, warrants further investigation.