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Updated: Oct 15, 2025
Retinal Vascular Reactivity as Assessed by Optical Coherence Tomography Angiography
Published on: March 26, 2020
Retinal and peripapillary vessel density increase in recovered COVID-19 children by optical coherence tomography
Noemi Guemes-Villahoz1, Barbara Burgos-Blasco1, Pilar Perez-Garcia1
1Ophthalmology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Insights
Children recovered from COVID-19 show increased retinal blood vessel density and flow shortly after infection. These changes may serve as a biomarker for vascular issues in other organs.
Area of Science:
- Ophthalmology
- Pediatrics
- Vascular Biology
Background:
- Coronavirus disease (COVID-19) can affect multiple organ systems, including the vasculature.
- Retinal microvasculature offers a non-invasive window to assess systemic vascular health.
- Understanding post-COVID-19 vascular changes in children is crucial for long-term health monitoring.
Purpose of the Study:
- To evaluate retinal vascular changes in children after COVID-19 recovery using optical coherence tomography angiography (OCTA).
- To compare OCTA findings in recovered COVID-19 children with age-matched healthy controls.
Main Methods:
- A cross-sectional case-control study involving 27 children recovered from COVID-19 and 45 healthy controls (ages 6-18).
- Ophthalmological examination including fundus photography and macular/optic disc OCTA.
- Analysis of superficial capillary plexus (SCP) parameters and peripapillary flux index (FI) using OCTA.
Main Results:
- Increased retinal vessel density (VD) and macular perfusion density (mPD) in the inner ring of the macular SCP in recovered COVID-19 children compared to controls.
- Significantly higher peripapillary flux index (FI) in all quadrants in the COVID-19 group.
- These vascular changes were observed 4-8 weeks post-COVID-19 diagnosis.
Conclusions:
- Children recovering from COVID-19 exhibit elevated retinal vascular density and flow.
- These OCTA-derived parameters may act as potential in vivo biomarkers for vascular abnormalities in pediatric COVID-19 survivors.
- Further research is warranted to explore the long-term implications of these findings.
Purpose:
To evaluate retinal vascular changes in children who have recovered from coronavirus disease (COVID-19) using optical coherence tomography angiography (OCTA) and to compare the results with age-matched healthy children.
Methods:
In this cross-sectional case-control study, children 6-18 years of age with laboratory-confirmed SARS-CoV-2 infection were compared with historic healthy controls. All participants underwent ophthalmological examination, including fundus photography and OCTA of the macular region and optic disk. COVID-19 children were examined 4-8 weeks after COVID-19 diagnoses. Demographic data, medical history, and COVID-19 symptoms were noted. OCTA parameters in the superficial capillary plexus (SCP) were analyzed according to ETDRS sectors and peripapillary quadrants.
Results:
A total of 72 patients were included: 27 recovered COVID-19 children and 45 controls. Mean age for cases was 11.96 ± 3.8 years (18 females [66%]); for controls, 11.02 ± 2.0 years (29 females [64%]). Macular OCTA of the SCP showed a significant increase in retinal vessel density (VD) in recovered COVID-19 children compared with healthy controls in the inner ring (P = 0.001). Macular perfusion density (mPD) was also increased in the inner ring (P = 0.001). Peripapillary OCTA evidenced a significant higher flux index (FI) in all four quadrants (P < 0.001).
Conclusions:
Recovered COVID-19 children present increased retinal VD, mPD, and peripapillary FI shortly after recovery. Since the retinal vasculature is considered a unique window to assess microvascular changes, these findings may represent a potential in vivo biomarker of vascular abnormalities in COVID-19 children in other organs.
