Early retinal, optic disc and choriocapillaris microvascular alterations in children with type 1 diabetes without...

To assess retinal, optic disc, and choriocapillaris microvascular changes in children with type 1 diabetes mellitus (T1DM) using optical coherence tomography angiography (OCTA).

This cross-sectional study included 154 children, comprising 77 children with T1DM and 77 healthy controls. One eye from each participant was analyzed. OCTA was used to evaluate vessel density in the superficial and deep capillary plexuses, foveal avascular zone area, radial peripapillary capillary vessel density, and choriocapillaris non-perfused area (NPCA) ratios. Foveal thickness and subfoveal choroidal thickness were measured using optical coherence tomography. Age, sex, body mass index, and HbA1c levels were recorded for all participants, along with disease duration and daily insulin dose in the T1DM group.

Superficial capillary plexus vessel density and foveal avascular zone parameters did not differ significantly between the T1DM and control groups (p > 0.05). Deep capillary plexus vessel density was also comparable between groups across most regions; however, superior hemi-area vessel density was higher in the T1DM group on unadjusted analysis (p < 0.05). Radial peripapillary capillary vessel density in the peripapillary region and whole-image analysis showed no significant differences between groups (p > 0.05). In contrast, intrapapillary vessel density was lower in children with T1DM (p < 0.05). Choriocapillaris NPCA ratio and foveal thickness were increased in the T1DM group (p < 0.05), while subfoveal choroidal thickness showed no significant difference between groups (p > 0.05).

Children with T1DM without clinical retinopathy may show early microvascular alterations on OCTA, particularly increased central choriocapillaris non-perfusion and reduced intrapapillary vessel density. These findings support the potential value of OCTA in detecting preclinical ocular microvascular involvement in pediatric T1DM before clinically detectable retinopathy develops.