RETINAL AND PERIPAPILLARY MICROVASCULAR FEATURES IN PEDIATRIC HENOCH-SCHÖNLEIN PURPURA WITHOUT OCULAR INVOLVEMENT: An Optical Coherence Tomography Angiography Study.

Abstract

To evaluate subclinical retinal and peripapillary microvascular alterations in pediatric patients with Henoch-Schönlein purpura (HSP) without ocular involvement using optical coherence tomography angiography. This prospective observational study included 95 right eyes of 95 children aged 5 years to 15 years, comprising 40 patients with HSP and 55 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic examination and optical coherence tomography angiography imaging. Quantitative parameters included superficial capillary plexus and deep capillary plexus vessel densities (VD) in foveal, parafoveal, and perifoveal regions; foveal avascular zone area; radial peripapillary capillary-VD; and peripapillary retinal nerve fiber layer thickness. Intergroup comparisons and correlation analyses between optical coherence tomography angiography metrics and disease duration, clinical finding score, and disease activity score were performed in the HSP group. Baseline ocular parameters were comparable between the HSP and control groups, except for lower central corneal thickness ( P = 0.002). Optical coherence tomography angiography revealed significantly decreased foveal superficial capillary plexus-VD ( P = 0.003) and decreased deep capillary plexus-VD in the nasal perifoveal region ( P = 0.004) in patients with HSP. Correlation analysis revealed that foveal avascular zone area positively correlated with disease duration (r = 0.48, P = 0.001), whereas parafoveal superficial capillary plexus-VD negatively correlated with clinical finding score (r = -0.45, P = 0.004). In addition, nasal perifoveal deep capillary plexus-VD showed significant negative correlations with both clinical finding score (r = -0.52, P < 0.001) and disease duration (r = -0.44, P = 0.005). Pediatric patients with HSP without clinical ocular involvement demonstrate measurable macular microvascular impairment and foveal avascular zone enlargement on optical coherence tomography angiography. Optical coherence tomography angiography may serve as a sensitive, noninvasive tool for early detection of subclinical retinal vascular alterations, facilitating risk stratification and individualized ophthalmic monitoring.