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The vascular endothelium is considered a central target of post-viral dysregulation, yet paediatric evidence for microvascular involvement is limited. Retinal imaging enables non-invasive assessment of microvascular structure and function and may help to clarify whether endothelial dysregulation is present in children with post-COVID-19 syndrome (PCS). Retinal vessel diameters and flicker-induced vasoreactivity were assessed at baseline and after a median of 14 weeks. Compared with matched healthy controls, multivariable analyses showed that PCS independently predicted wider central retinal arteriolar equivalent (CRAE\u2009+\u200928.1\u00a0\u03bcm, 95% CI 21.7\u201334.5,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and central retinal venular equivalent (CRVE\u2009+\u200921.7\u00a0\u03bcm, 95% CI 15.8\u201327.7,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), with a higher arteriolar-to-venular ratio (AVR\u2009+\u20090.038 units, 95% CI 0.012\u20130.064,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.005). These findings suggest a distinct microvascular pattern in children with PCS that is consistent with endothelial dysregulation months after infection. While no significant group-level changes were observed at follow-up, children with particularly large venular diameters and reduced flicker responses showed the greatest improvement. Longer follow-up intervals predicted decreasing venular diameter, and reductions in symptom burden correlated with increasing AVR over time. Together, these results indicate heterogeneous, time-dependent changes in microvascular parameters. Retinal vessel analysis may provide a useful, non-invasive approach to characterising vascular involvement in paediatric PCS and improving understanding of post-viral sequelae.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-54086-y","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:12:16Z","timestamp":1780499536000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retinal microvascular alterations consistent with endothelial dysregulation in paediatric post-COVID-19 syndrome: A prospective matched-cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Pia-Sophie","family":"Lamprecht","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Streese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henner","family":"Hanssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lorenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Klee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Proquitt\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Vilser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"54086_CR1","unstructured":"consensus World Health Organization A clinical case definition for post COVID-19 condition in children and adolescents. ; date of access: February 16, 2025, (2023). 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