Increased choriocapillaris non-perfusion in pediatric hypertension assessed by optical coherence tomography angiography(OCTA)

Abstract Purpose To evaluate retinal microvascular changes in pediatric patients with systemic hypertension compared with healthy controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods This prospective cross-sectional study included 94 pediatric patients (94 eyes; age 6–18 years) with systemic hypertension followed for at least one year and 60 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic examination. OCT was used to measure foveal thickness (FT) and subfoveal choroidal thickness (SFCT). OCTA assessed vascular density (VD) in the superficial and deep capillary plexuses (SCP, DCP), optic nerve head (ONH), foveal avascular zone (FAZ), and choriocapillaris non-perfused area (NPCA) ratio. Body mass index (BMI) and microalbuminuria status were recorded. Statistical analysis was performed using SPSS v20.0. Results FT, SFCT, SCP, DCP, FAZ, and ONH VD did not differ significantly between hypertensive patients and controls (p > 0.05). In contrast, NPCA ratios were significantly higher in the hypertensive group across all measured regions (0.5 mm, 0.5–1.5 mm, and 1.5–3 mm; p < 0.0001). Within the hypertensive group, microalbuminuria-negative patients showed higher NPCA ratios in the 0.5 mm and 0.5–1.5 mm regions compared with microalbuminuria-positive patients (p < 0.05), although post hoc power was low. BMI demonstrated a weak negative correlation with DCP vessel density (p < 0.05). In multivariable regression analysis, systemic hypertension remained independently associated with increased NPCA values after adjustment for age, sex, and BMI. Conclusion Pediatric patients with systemic hypertension without clinical retinopathy show increased choriocapillaris non-perfusion on OCTA, suggesting early subclinical microvascular involvement. OCTA-derived NPCA measurements may reflect early subclinical microvascular alterations associated with pediatric hypertension in children before conventional funduscopic findings become apparent.