Purpose

To describe the clinical course of papillitis and to investigate the diagnostic value of the retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) in pediatric uveitis.

Methods

Demographic and clinical data of 102 children (157 affected eyes) with papillitis and uveitis were collected retrospectively. Papillitis was defined as a swollen optic disc, with blurred disc margins seen on fundoscopy and/or optic disc fluorescein staining or leakage on fluorescein angiography (FA). Receiver operating characteristics (ROC) analysis was performed, comparing FA (golden standard) to OCT-RNFL. An ideal cut-off was determined for OCT-RFNL by calculation of the highest Youden index.

Results

The occurrence of papillitis was 18% (24/131) in anterior uveitis, 84% (27/32) in intermediate uveitis, and 65% (52/80) in panuveitis patients. Systemic corticosteroids and immunomodulatory therapy were initiated within the first month after diagnosis of papillitis in 8% and 49% of the patients, respectively. The OCT-RNFL values were significantly higher at diagnosis than after resolution of papillitis (165 vs. 122µm, p <0.001). The optimal cut-off value of OCT-RNFL for diagnosing papillitis was 135µm, with a sensitivity and specificity of 73% and 95%, respectively, and based on 87/243 (39%) uveitis patients with FA.

Conclusions

Papillitis can affect 42% of the children with uveitis and is especially frequent in intermediate and panuveitis. It is often a reason to level-up the immunosuppressive treatment, fortunately with a positive overall outcome in most cases. OCT-RNFL is a useful additional non-invasive imaging tool in the diagnosis and follow-up of papillitis in pediatric uveitis patients.