Evaluation Of Corneal Parameters In Patients With Paediatric Onset Multiple Sclerosis Started With Optic Neuritis

Pediatric onset multiple sclerosis(POMS), when multiple sclerosis(MS) begins before the age of 18, is becoming more recognised.About 5% of MS cases happen before the age of 18.In paediatric optic neuritis, between 13.8 and 32% convert to MS, and a higher risk has been reported in those with abnormal brain imaging at onset, those with bilateral optic neuritis and those with recurrent optic neuritis.Despite being rare, it has distinct characteristics, a younger age at onset and slower progression. Despite this, people with POMS reach disability milestones earlier than people with MS.This study evaluates corneal parameters in pediatric-onset MS started with optic neuritis (POMS-ON) in order to diagnose any corneal co-morbidities, if present.

This is a single centre trial which was conducted at İstanbul University-Cerrahpaşa Medical School in collaboration with the Department of Child Neurology and the Department of Ophthalmology in İstanbul, Turkey.

In this cross-sectional study, 30 eyes of 22 POMS-ON patients and 20 eyes of 20 healthy subjects were evaluated. Best corrected visual acuity (BCVA), color vision levels with Ishihara’s test with 24 plates, biomicroscopic and fundoscopic examinations were performed at the ophthalmology outpatient clinic of our university. Corneal tomographic analyses were performed with the Pentacam-HR device, and specular microscopic analyses were performed with the CellCheck SL Premier Endothelial Analytics program of Konan Medical device. The medications used by the patients in the POMS-ON group were also documented as well sex and age. The same examinations and analyses were performed in the healthy group, which was balanced for age and gender.

Cell density,coefficient of variation,hexagonality and pachymetry values were evaluated by specular microscopy and no statistically significant difference was found between POMS-ON and control group,nor between affected and healthy eyes in monoocular POMS-ON.The mean flat keratometry(K1),the mean steep keratometry(K2),the mean maximal corneal curvature(Kmax),astigmatism,the thinnest corneal thickness,anterior chamber depth,corneal volume and the chamber volume values were evaluated by Pentacam-HR no statistically significant difference was found between POMS-ON and control group,nor between affected and healthy eyes in monoocular POMS-ON.Only 33,33% POMS-ON eyes had color vision impairment and in 90% of POMS-ON eyes,BCVA in logMAR was 0.00.

In conclusion, in our study, no statistically significant difference was found in corneal parameters in POMS-ON, that can impair visual functions when compared to the healthy group. In the monocular POMS-ON subgroup analysis, no statistically significant difference was found between the affected eye and the healthy eye. We believe that it would be beneficial to conduct studies with larger patient numbers in order to protect visual functions, optimize diagnosis, treatment and follow-up in this disease that can cause visual function loss, and also to analyze possible cumulative ocular side effects of systemic treatment with multimodal imaging regarding that POMS-ON patients may be treated with systemic treatment for years.