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Changes in retinal and choroidal capillary dynamics in patients with multisystem inflammatory syndrome in children
Tuğba Kurumoğlu Incekalan1, Umit Celik2, Orkun Tolunay2
1Depertmant of Opthalmology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey. tugbakurumoglu@hotmail.com.
Insights
Multisystemic inflammatory syndrome in children (MIS-C) causes retinal microvascular changes, particularly affecting the deep capillary plexus and choroid. Optical coherence tomography angiography can detect these ocular changes, which correlate with C-reactive protein levels.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Multisystemic inflammatory syndrome in children (MIS-C) is a rare but serious complication of SARS-CoV-2 infection.
- Ocular involvement in MIS-C can manifest as microvascular changes affecting retinal and choroidal circulation.
- Early detection of these changes is crucial to prevent permanent vision impairment.
Purpose of the Study:
- To evaluate the impact of MIS-C on retinal and choroidal circulation using optical coherence tomography angiography (OCTA).
- To assess changes in choroidal thickness and retinal microvasculature during active MIS-C and after inflammation resolution.
- To investigate the correlation between C-reactive protein (CRP) levels and ocular microvascular alterations in MIS-C patients.
Main Methods:
- A cohort of 19 patients (38 eyes) diagnosed with MIS-C was studied.
- OCTA measurements of choroidal thickness and vessel density in the radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), and deep capillary plexus (DCP) were performed at diagnosis and 60 days later.
- Correlations between CRP levels at diagnosis and OCTA findings were analyzed.
Main Results:
- Active MIS-C was associated with enlarged foveal avascular zones, reduced SCP and DCP vessel density, and increased choroidal thickness compared to post-recovery.
- Significant negative correlations were found between CRP levels and SCP/DCP vessel density, and a positive correlation with choroidal thickness.
- The deep capillary plexus and choroid showed particularly marked effects in MIS-C patients.
Conclusions:
- MIS-C significantly impacts retinal and choroidal microvasculature, with notable effects on the DCP and choroid.
- OCTA can detect these microvascular changes, which correlate with systemic inflammation markers like CRP.
- OCTA may serve as a valuable tool for monitoring ocular health and detecting early signs of damage in MIS-C patients.
Purpose:
To evaluate patients with multisystemic inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using optical coherence tomography angiography (OCTA) during and after resolution of inflammation to investigate the effect of this entity on the retinal and choroidal circulation.
Methods:
The study included 38 eyes of 19 patients diagnosed as having MIS-C between March 2021 and June 2021. OCTA measurements of choroidal thickness and vessel density in the radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), and deep capillary plexus (DCP) obtained at time of diagnosis and 60 days later were compared. Correlations between C-reactive protein (CRP) levels at diagnosis and retinochoroidal involvement were investigated.
Results:
Compared to post-recovery follow-up examinations, patients with active MIS-C showed foveal avascular zone enlargement (p = 0.031), decreased vessel density in the temporal parafoveal SCP (p = 0.047) and all parafoveal areas of the DCP (p < 0.05 for all), and increased choroidal thickness (p = 0.021). Correlation analysis between CRP levels and OCTA changes during MIS-C revealed significant negative correlations with all parafoveal sectors of the SCP and DCP and a significant positive correlation with CT.
Conclusion:
There were especially marked effects on the DCP and choroid in MIS-C patients. Our findings also correlate with CRP levels. The use of optical coherence tomography angiography in patients with multisystemic inflammatory syndrome may have potential future implications for detecting ocular microvascular changes that occur before permanent damage develops. Clinical Trial Registration Number and Date: 77/1340; March 1, 2021.
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