Retinal Vascular Structures, Choroidal Thickness Not Linked With Celiac Disease

Small girl having her eyes checked at ophthalmologist while her father is supporting her.
In pediatric patients with Celiac disease, research shows a nonsignificant increase in foveal avascular zone and decrease in subfoveal choroidal thickness.

Retinal vasculature and subfoveal choroidal thickness do not vary significantly between children with celiac disease and their peers, according to a study published in Journal of the American Association of Pediatric Ophthalmology and Strabismus.

Prior research has shown that celiac disease in most patients carries extraintestinal symptoms. Autoantibodies involved in celiac disease target tissue transglutaminase 2 (TG2). Researchers used spectral domain optical coherence tomography angiography (SD OCT-A) to determine whether these autoantibodies could affect the choroid and retain of pediatric patients with celiac disease. 

Sixty children with celiac disease and 71 healthy control individuals underwent comprehensive eye exams. Their age, intraocular pressure (IOP), spherical equivalent, axial length (AL), and vascular density (VD) of superficial and deep capillary vascular plexus were not significantly different.

Patients with celiac disease had larger foveal avascular zone (FAZ 0.306±0.12 mm2 vs 0.287±0.11 mm2) and thinner subfoveal choroid thickness (309.9±76.97 μm vs 328±68.51 μm) compared with the control group, but the differences were not significant (P =.383, P =.157, respectively).

The researchers said that prior research has shown inflammatory diseases with vascular involvement prompt choroid thickening through long-term damage to the microvasculature and following atrophy. Studies have indicated FAZ area can change in ischemic or inflammatory diseases.

“FAZ enlargement associated with ischemia has been observed in Alzheimer’s disease and diabetes mellitus, whereas decreased FAZ area associated with inflammation has been observed in the active phase of inflammatory bowel disease compared with patients in remission,” the researchers said. “Prolonged autoimmune disorders trigger a low-grade chronic inflammation, microvascular damage, glial proliferation, and progressive apoptosis of the photoreceptors. FAZ enlargement and choroidal thinning might be expected to result from chronic inflammation and ischemia.”

“Chronic inflammation, circulating immune-complexes and disruption of angiogenesis may involve retinal vasculature in CD, but there is not yet enough data to explain the role of angiogenesis in the pathogenesis of celiac disease,” according to the report.

Limitations of the study included small number of patients, short follow-up period, and failure to separate patients by gluten-free diet.


Isik I, Yaprak L, Yaprak A, et al. Optical coherence tomography angiography findings of retinal vascular structures in children with celiac disease. J AAPOS. Published online January 24, 2022. doi:10.1016/j.jaapos.2021.11.008