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Retinal examination allows to non\u2010invasively observe the vasculature of an end\u2010organ. We observe alterations in long\u2010term childhood cancer survivors (CCS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the Cardiac and Vascular Late Sequelae in Long\u2010Term Survivors of Childhood Cancer\u2010Study, 1002 CCS (23\u201348\u2009years) having neoplasia prior to 15\u2009years of age were prospectively enrolled in a general and ophthalmologic examination including fundus photography. Central retinal vessel equivalents (arterial: CRAE; venous CRVE) were measured and linear regression analysis was computed to compare CCS to controls from the population\u2010based Gutenberg Health Study (GHS) with adjustment for potential cardiovascular and ophthalmological confounders. Differences in cancer types and treatments were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For 837 CCS (45.3% female), CRAE and CRVE were conducted. Both were smaller in CCS previously having leukaemia, central nervous system tumour, neuroblastoma, renal tumour, malignant bone tumour, soft tissue sarcoma and germ cell tumour than in GHS controls. No difference was found for CCS with prior lymphoma. Previous radiotherapy of head or neck was associated with a smaller CRVE. Higher mean arterial blood pressure and intake of antihypertensive medication were associated with smaller CRAE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Retinal vasculature is altered in CCS leading to smaller retinal arteries and veins. Our finding indicates that childhood cancer and its treatment leads to systemic alterations of the microcirculation on both branches of the vasculature system. While the retinal venous vasculature is altered by radiotherapy, the lower vessel width of the arterial branch is associated with arterial hypertension.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.17438","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T13:19:52Z","timestamp":1737638392000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Altered retinal vasculature in childhood cancer survivors: Data from the German <scp>CVSS<\/scp>\u2010study"],"prefix":"10.1111","volume":"103","author":[{"given":"Alexander K.","family":"Schuster","sequence":"first","affiliation":[{"name":"Department of Ophthalmology University Medical Center Mainz  Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5075-7377","authenticated-orcid":false,"given":"Anna Maria","family":"Voigt","sequence":"additional","affiliation":[{"name":"Department of 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E.","family":"Beutel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy University Medical Center Mainz  Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Center for Cardiology University Medical Center of the Johannes Gutenberg\u2010University Mainz  Mainz Germany"},{"name":"Center for Thrombosis and Hemostasis University Medical Center of the Johannes Gutenberg\u2010University Mainz  Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl J.","family":"Lackner","sequence":"additional","affiliation":[{"name":"Institute for Clinical Chemistry and Laboratory Medicine University Medical Center of the Johannes Gutenberg\u2010University Mainz  Mainz 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