Retinal and choroidal microvascular alterations in ıdiopathic pulmonary fibrosis: an OCTA study

To evaluate retinal and choroidal microvascular changes in patients with idiopathic pulmonary fibrosis (IPF) using optical coherence tomography angiography (OCTA), and to explore whether IPF, traditionally considered a pulmonary disease, also manifests in the ocular microcirculation.

In this cross-sectional case-control study, 82 IPF patients and 82 age-, sex-, and eye-side-matched healthy controls were enrolled. All participants underwent comprehensive ophthalmic examination and macular OCTA imaging using the RTVue XR Avanti device. Vessel density (VD), foveal avascular zone (FAZ) area and perimeter (PERIM), flow area, selected area, and perfusion density were assessed in the superficial and deep capillary plexuses, outer retina, and choriocapillaris.

The IPF group exhibited significantly lower superficial foveal vessel density (p = 0.030), reduced outer retina selected area (p = 0.010), and decreased choriocapillaris selected area (p = 0.003) compared to controls. No significant differences were observed in FAZ area or deep plexus vessel densities.

Patients with IPF demonstrate measurable microvascular alterations in both the superficial retina and choriocapillaris, supporting the concept of IPF as a systemic disease with extra-pulmonary vascular involvement. OCTA may serve as a non-invasive imaging biomarker for detecting systemic microangiopathy in fibrotic lung disease.