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Retinal microvascular alterations consistent with endothelial dysregulation in paediatric post-COVID-19 syndrome: A
Pia-Sophie Lamprecht1, Lukas Streese2,3, Christoph Hauser4
1Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, 07747, Jena, Germany.
Insights
Children with post-COVID-19 syndrome (PCS) show distinct microvascular changes in their retinas, suggesting endothelial dysregulation. Retinal imaging offers a non-invasive way to study these persistent post-viral effects in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatrics
- Cardiovascular Research
Background:
- Persistent symptoms following SARS-CoV-2 infection in children (post-COVID-19 syndrome or PCS) are poorly understood, with limited objective biological markers.
- The vascular endothelium is implicated in post-viral issues, but pediatric evidence of microvascular involvement is scarce.
Purpose of the Study:
- To investigate microvascular changes in children with PCS using non-invasive retinal imaging.
- To assess for endothelial dysregulation as a potential correlate of PCS in pediatric patients.
Main Methods:
- Retinal vessel diameters (central retinal arteriolar equivalent and central retinal venular equivalent) and flicker-induced vasoreactivity were measured in children with PCS and healthy controls.
- Measurements were taken at baseline and after a median of 14 weeks, with multivariable analyses used for comparison.
Main Results:
- Children with PCS exhibited significantly wider retinal arterioles (CRAE) and venules (CRVE) compared to controls, indicating a distinct microvascular pattern.
- A higher arteriolar-to-venular ratio (AVR) was observed in PCS patients, consistent with endothelial dysregulation.
- While no significant group-level changes occurred at follow-up, improvements in symptoms correlated with increasing AVR over time.
Conclusions:
- Retinal vessel analysis reveals a unique microvascular signature in pediatric PCS, suggesting persistent endothelial dysfunction.
- This non-invasive approach may aid in understanding post-viral sequelae and characterizing vascular involvement in children.
- Microvascular parameters show heterogeneous and time-dependent changes, highlighting the complexity of long-term post-COVID-19 effects.
Abstract:
Persistent symptoms following SARS-CoV-2 infection in children remain poorly understood, and objective biological correlates are scarce. The vascular endothelium is considered a central target of post-viral dysregulation, yet paediatric evidence for microvascular involvement is limited. Retinal imaging enables non-invasive assessment of microvascular structure and function and may help to clarify whether endothelial dysregulation is present in children with post-COVID-19 syndrome (PCS). Retinal vessel diameters and flicker-induced vasoreactivity were assessed at baseline and after a median of 14 weeks. Compared with matched healthy controls, multivariable analyses showed that PCS independently predicted wider central retinal arteriolar equivalent (CRAE + 28.1 μm, 95% CI 21.7-34.5, p < 0.001) and central retinal venular equivalent (CRVE + 21.7 μm, 95% CI 15.8-27.7, p < 0.001), with a higher arteriolar-to-venular ratio (AVR + 0.038 units, 95% CI 0.012-0.064, p = 0.005). These findings suggest a distinct microvascular pattern in children with PCS that is consistent with endothelial dysregulation months after infection. While no significant group-level changes were observed at follow-up, children with particularly large venular diameters and reduced flicker responses showed the greatest improvement. Longer follow-up intervals predicted decreasing venular diameter, and reductions in symptom burden correlated with increasing AVR over time. Together, these results indicate heterogeneous, time-dependent changes in microvascular parameters. Retinal vessel analysis may provide a useful, non-invasive approach to characterising vascular involvement in paediatric PCS and improving understanding of post-viral sequelae.
