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Macular microvascular changes in children with transfusion-dependent beta-thalassemia

  • Retinal Disorders
  • Published:
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A Correction to this article was published on 11 January 2022

This article has been updated

Abstract

Background

To investigate the effect of iron overload on macular perfusion among transfusion-dependent thalassemia (TDT) patients using optical coherence tomography angiography (OCTA)

Methods

The study is a prospective observational case–control study. It included 27 eyes from 27 children with transfusion-dependent β-thalassemia and 25 eyes from 25 age-matched controls.

All participants were evaluated clinically and with OCTA Avanti RTVue-XR system (Optovue) to assess macular microvascular changes, by measuring vessels density (VDs) and foveal avascular zone (FAZ) area, at both superficial and deep retinal plexuses and at choriocapillaris level.

Results

Foveal and parafoveal zones were significantly thinner among thalassemia patients, with significantly larger FAZ area at the level of both superficial and deep retinal plexuses when compared with control group. The thalassemia group showed significant lower values compared with the controls regarding whole-image, foveal, and parafoveal deep VD. There were significant negative correlations between serum ferritin and deep (whole image and parafoveal) VD (r =  − 0.429, P = 0.026, and r =  − 0.452, P = 0.018, respectively). Choriocapillaris VDs (whole image and foveal) showed significant negative correlations with serum ferritin levels (r =  − 0.390, P = 0.044 and r =  − 0.401, P = 0.038, respectively)

Conclusions

Macular microvascular changes were detected by OCTA examination in patients with TDT, mostly due to iron overload effect, as we selected patients on iron-chelating agent with the least harmful effect on the retina. The most affected layer is the DCP. Changes at the deep layer could be used as a sensitive biomarker for early macular perfusion changes in those patients.

Trial registration

Study registration number is UMIN000042657, date of registration: 2020/12/04 (retrospectively registered).

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Change history

Abbreviations

TI:

Thalassemia intermedia

NTDT:

Non-transfusion-dependent thalassemia

TM:

Thalassemia major

TDT:

Transfusion-dependent thalassemia

OCTA:

Optical coherence tomography angiography

BCVA:

Best-corrected visual acuity

LogMAR VA:

Logarithm of the minimum angle of resolution visual acuity

BIO:

Binocular indirect ophthalmoscopy

GAT:

Goldmann applanation tonometry

CFP:

Color fundus photography

SSI:

Signal strength index

SPSS:

Statistical package for the social sciences

SSADA:

Split-spectrum amplitude-decorrelation angiography

SCP:

Superficial capillary plexus

ILM:

Internal limiting membrane

IPL:

Inner plexiform layer

DCP:

Deep capillary plexus

OPL:

Outer plexiform layer

VD:

Vessel area density

FAZ:

Foveal avascular zone

ROI:

Circle region of interest

DFP:

Deferiprone

ICP:

Intermediate capillary plexus

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Authors and Affiliations

  1. Faculty of Medicine, Minia University, El-Minya, Egypt

    Heba Radi AttaAllah, Suzan Omar Mousa & Ismail Ahmed Nagib Omar

Authors
  1. Heba Radi AttaAllah
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  2. Suzan Omar Mousa
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  3. Ismail Ahmed Nagib Omar
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Contributions

HRA participated in conception and design of this work, data acquisition (OCTA examination for all participants), collection and analysis, in literature search and manuscript writing. IANO participated in data collection (ophthalmic examination for all participants), analysis and statistical analysis, and in literature search and manuscript writing. SOM participated in data collection (pediatric evaluation) and data analysis and manuscript editing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Heba Radi AttaAllah.

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Ethics approval

The study had gained approval from Local Research Ethics Committee, Faculty of Medicine, Minia University Hospitals. The study was conducted in accordance with the tenets of the Helsinki Declaration. Study registration number is UMIN000042657.

Informed consent

Written consent form was signed by parents or legal guardians for their child’s participation in the study.

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AttaAllah, H.R., Mousa, S.O. & Omar, I.A.N. Macular microvascular changes in children with transfusion-dependent beta-thalassemia. Graefes Arch Clin Exp Ophthalmol 259, 3283–3293 (2021). https://doi.org/10.1007/s00417-021-05275-0

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  • DOI: https://doi.org/10.1007/s00417-021-05275-0

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