Early Signs of Microvascular Impairment on Optical Coherence Tomography Angiography in Pediatric Patients With Type 1 Diabetes Without Clinical Retinopathy

Purpose: To assess microvascular changes on optical coherence tomography angiography (OCTA) in children with type 1 diabetes mellitus (DM). Methods: PubMed, Web of Science, and Scopus were searched to identify observational studies reporting OCTA metrics in patients with type 1 DM without clinically evident diabetic retinopathy as well as age-matched controls. Standardized mean differences were pooled using a random-effects model. Subgroup analyses and meta-regression assessed diabetes duration, glycosylated hemoglobin, eye selection, age differences, and sex distribution. Results: This meta-analysis incorporated data from 11 studies. Our results showed that, compared with healthy controls, children with type 1 DM had a significantly enlarged area (standardized mean difference, 0.25) and increased perimeter (standardized mean difference, 0.42) of foveal avascular zone (FAZ). Mean foveal and perifoveal superficial capillary plexus vessel density and mean foveal deep capillary plexus vessel density did not differ between the patients with DM and healthy controls (standardized mean difference, −0.17, −0.67, and −0.21, respectively). However, the mean parafoveal superficial capillary plexus (standardized mean difference, −0.50), mean parafoveal deep capillary plexus (standardized mean difference, −0.44), mean perifoveal deep capillary plexus (standardized mean difference, −0.43), optic nerve whole image (standardized mean difference, −0.36), and peripapillary (standardized mean difference, −0.43) vessel densities were lower in patients with type 1 DM compared with healthy controls. Conclusion: Compared with healthy children, the eyes of patients with type 1 DM have higher values for the FAZ area and perimeter and a lower vessel density in the parafoveal, perifoveal, and optic nerve head areas. These findings may provide insight into early retinal changes relevant for future screening strategies in pediatric patients with type 1 DM.