OCTA-based evaluation of retinal microvascular changes during recombinant GH therapy in children with GH deficiency

To evaluate retinal microvascular changes in children with growth hormone deficiency (GHD) using optical coherence tomography angiography (OCTA) and to describe longitudinal OCTA changes observed over six months in children with GHD receiving growth hormone replacement therapy, using healthy controls as a baseline reference. This prospective, single-center, longitudinal observational study included 19 children aged 7–17 years with GHD and 19 age-matched healthy controls. Comprehensive ophthalmic evaluations were performed, including OCTA imaging using the AngioVue system. Vessel density (VD), retinal thickness, and foveal avascular zone (FAZ) parameters were evaluated in predefined macular regions. Radial peripapillary capillary (RPC) vessel density and retinal nerve fiber layer (RNFL) thickness were also measured. Follow-up OCTA examinations were conducted after six months of recombinant growth hormone therapy at a dose of 35 µg/kg/day. Right eye data were used for all analyses to avoid inter-eye correlation. Compared to controls, GHD patients exhibited significantly reduced vessel density in the SCP whole image (47.8 ± 3.1% vs. 50.8 ± 2.8%, p = 0.004) and parafoveal region (51.2 ± 3.4% vs. 52.6 ± 3.2%, p = 0.046), and in the DCP parafoveal region (58.3 ± 4.7% vs. 60.4 ± 4.5%, p = 0.043). RNFL thickness was significantly lower in the GHD group overall (96.2 ± 8.1 vs. 100.5 ± 7.6 μm, p = 0.015) and in the inferior (96.3 ± 7.2 vs. 101.8 ± 6.9 μm, p = 0.007) and superior (97.6 ± 6.5 vs. 100.9 ± 7.4 μm, p = 0.034) quadrants. RPC vessel density was also significantly lower (50.1 ± 4.1% vs. 53.2 ± 3.9%, p = 0.011). No significant difference was observed in FAZ area between groups ( p > 0.05). After six months of GH therapy, significant increases were observed in SCP whole image vessel density (47.8 ± 3.1% to 49.6 ± 2.9%, p = 0.030), RNFL mean thickness (96.2 ± 8.1 to 99.3 ± 7.8 μm, p = 0.002), RNFL inferior quadrant (96.3 ± 7.2 to 101.4 ± 6.9 μm, p = 0.030), and RPC vessel density (50.1 ± 4.1% to 52.4 ± 3.7%, p = 0.005). OCTA enables noninvasive detection of retinal microvascular alterations in children with GHD. These findings describe baseline microvascular differences between children with GHD and healthy controls, as well as longitudinal OCTA changes observed during GH therapy, and suggest that retinal microvascular changes were observed during growth hormone therapy in children with GHD, supporting the potential utility of OCTA for clinical monitoring.