Systemic sclerosis: Correlations of OCTA, capillaroscopy and elastography in microvascular assessment

Systemic sclerosis (SSc) is a connective tissue disorder characterized by microvascular injury, autoimmunity, and excessive collagen deposition leading to fibrosis. Despite advances in understanding peripheral microvascular changes, the relationship between retinal, peripheral, and systemic vascular involvement remains inadequately explored.

To evaluate and correlate optical coherence tomography angiography (OCTA), nailfold capillaroscopy (NC), and transient elastography findings in SSc patients.

This prospective single-center study enrolled 40 SSc patients (2013 ACR/EULAR criteria) and 45 healthy controls between December 2024 and August 2025. All participants underwent comprehensive ophthalmologic examination with OCTA imaging, NC evaluation, and liver stiffness measurement (LSM) using transient elastography. Retinal vessel density was assessed in superficial and deep capillary plexuses across macular and peripapillary regions. Clinical parameters including modified Rodnan skin score, disease duration, and organ involvement were recorded.

SSc patients showed significantly reduced deep parafoveal (p = 0.048), deep temporal (p = 0.025), and deep inferior (p = 0.019) vessel densities, with decreased superior retinal nerve fiber layer thickness (p = 0.024) versus controls. Active capillaroscopic patterns appeared in 60% of patients. Strong correlations existed between OCTA parameters and age, disease duration, and LSM (r=-0.409 p = 0.011 for DWI-age, r=-0.392 p = 0.015 for DWI-LSM). Diffuse cutaneous SSc demonstrated lower superficial vessel densities than limited disease (p = 0.010-0.023).

OCTA-detected retinal microvascular changes correlate significantly with peripheral microvascular damage and systemic fibrotic burden in SSc, representing a valuable non-invasive monitoring tool with preferential deep capillary plexus involvement reflecting systemic vasculopathy.