Corneal Endothelial Morphology and Thickness Changes in Children with Attention-

Deficit Hyperactivity Disorder

Merve Kalınlı1, Emre Aydemir2, Gözde Aksoy Aydemir2

1Child and Adolescent Psychiatry Department, Adıyaman University Training and Research Hospital, Adıyaman, Turkey

2Ophthalmology Department, Adıyaman University Training and Research Hospital, Adıyaman, Turkey

Purpose: The current study aims to assess corneal endothelial cell density (ECD),

morphology, and central corneal thickness (CCT) objectively between children with attention-

deficit hyperactivity disorder (ADHD) and a control group.

Materials and Methods:

Sixty-four eyes of 64 children with attention-deficit hyperactivity disorder and 55 eyes of 55

healthy subjects were included in this study. The patient group was divided into 2 according

to the use of methylphenidate (MPH). The symptom severity of ADHD in the children was

evaluated via the use of parent-reported measurements, which were collected using the

Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and rating

Scale (T-DSM-IV-S) and Conners Parent Rating Scale-48 (CPRS-48). After detailed

ophthalmologic examination, specular microscopy measurement was performed for all

participants. ECD, average cell area (ACA), coefficient of variation (CV), hexagonality ratio,

and CCT values were recorded. One-way ANOVA (with Bonferroni correction) was applied

for comparison between groups.

Results:

There were 34 children in the group using MPH and 30 children without MPH. There was no

age or gender difference between the 3 groups. Mean ECD and hexagonality ratio were lower
(p = 0.001 and p = 0.007) and both CV and ACA were higher (p = 0.007 and p = <0.001) in

patients with using MPH when compared to without MPH. There were significant correlations

between MPH usage duration and ECD, hexagonality ratio, CV and ACA (p = 0.015 r = -

0.383, p = <0.001 r = -0.686, p = 0.008 r = 0.417 and p = <0.001 r = 0.638 respectively).

Mean ECD and hexagonality ratio were lower (p = <0.001 and p = <0.001) and both CV and

ACA were higher (p = 0.002 and p = <0.001) in patients with using MPH when compared to

healthy subjects. There was no significant difference in all values between the patient group

who did not use MPH and the healthy subjects (p = >0.005). There was no significant

difference CCT between three groups (p > 0.005).

Conclusion:

In the literature, it has been shown that MPH exposure causes dose-dependent changes in rat

corneas. The corneal epithelium is affected in mild doses, while the corneal endothelium is

affected in high doses.1 Endothelial changes occurring with the duration of use in our study

also support this situation. Altered corneal endothelial function was found in ADHD with

MPH and the alteration increased as MPH usage duration. Care should be taken in terms of

endothelial dysfunction in children with ADHD receiving long-term MPH therapy. Routine

ophthalmology clinic control is recommended for children with ADHD receiving MPH

treatment. The small sample size and the cross-sectional nature of the study are the limitations

of our study. Further longitudinal follow-up studies and large patient series are needed to

determine whether MPH treatment has any effect on corneal endothelial morphology.

[1] Gozil, M., Take, G., Bahcelioglu, M., Tunc, E., Oktem, H., Caglar, G., Calguner, E., Erdogan, D., 2008. Dose-dependent ultrastructural

changes in rat cornea after oral methylphenidate administration. Saudi Med J. 29: 498–502.

Keywords: attention-deficit hyperactivity disorder, corneal endothelial cell density, corneal

endothelial function, specular microscopy