Evaluation of ocular findings in pediatric patients with liver disease associated with metabolic dysfunction

BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is common in children and may affect extrahepatic organs through systemic metabolic and inflammatory mechanisms. The retina and choroid may be potential targets of these effects. AIMS: To evaluate macular, peripapillary retinal nerve fiber layer (RNFL), and choroidal thickness in pediatric patients with MAFLD. METHODS: Children diagnosed with MAFLD and hepatic steatosis between July 2018 and December 2020 were included. Fifty-four patients with MAFLD and 46 healthy controls underwent comprehensive ophthalmic examination, including measurements of macular, peripapillary RNFL, and choroidal thickness using spectral-domain optical coherence tomography (OCT) (Spectralis, Heidelberg Engineering, Germany; software version 6.3.4). OCT parameters were compared between groups. RESULTS: The study included 54 patients with MAFLD and 46 healthy controls. All MAFLD patients had hepatic steatosis, and 15 (28%) were neither overweight nor obese. The groups were comparable in age. Weight, height, and BMI z-scores were significantly higher in the MAFLD group (p < 0.001, p = 0.026, and p < 0.001, respectively). No significant differences were observed in central macular thickness, global or nasal peripapillary RNFL thickness, subfoveal choroidal thickness, or temporal choroidal thickness at 500 µm from the fovea. However, temporal peripapillary RNFL, temporal choroidal thickness at 1500 µm, and nasal choroidal thicknesses at 500 and 1500 µm were thinner in the MAFLD group. Within the MAFLD group, the non-obese subgroup showed nominally lower Global RNFL (p = 0.005), NS RNFL (p = 0.012), and TI RNFL (p = 0.031) values. CONCLUSION: MAFLD may be associated with structural alterations in the peripapillary RNFL and choroid in pediatric patients.