Optic nerve head microcirculation on optical coherence tomography angiography is reduced in systemic lupus...

To quantify ocular microcirculation by optical coherence tomography angiography (OCTA) and peripheral microcirculation by nailfold videocapillaroscopy (NVC) in systemic lupus erythematosus (SLE), to compare OCTA/optical coherence tomography (OCT) metrics with healthy controls, and to explore NVC-ocular relationships.

In this single-center, cross-sectional case-control study, 32 SLE patients and 34 controls were evaluated at one visit. NVC was scored semi-quantitatively (EULAR-standardized) in SLE. OCTA provided macular superficial/deep plexus and optic nerve head/peripapillary radial peripapillary capillary (RPC) vessel density metrics; structural OCT measured peripapillary retinal nerve fiber layer (RNFL) thickness. Multiple testing was controlled with Benjamini-Hochberg false discovery rate (FDR). Exploratory ROC analysis and age/BMI-adjusted logistic regression were performed for inside-disc RPC vessel density (RPCID).

RPCID was lower in SLE than controls (50.6 [43.4-55.7] vs 55.3 [44.3-59.7]; FDR-adjusted p < 0.001) and showed good in-sample discrimination (AUC = 0.804). Higher RPCID was associated with lower odds of SLE after adjustment (OR = 0.737; 95% CI 0.625-0.869; p < 0.001). Within SLE, higher NVC dilation scores correlated with lower macular vessel density (deep superior sector: r =  - 0.384; FDR p = 0.041), and higher composite NVC morphology correlated with greater mean RNFL thickness (r = 0.505; FDR p < 0.05).

Optic nerve head/peripapillary microcirculation is reduced in SLE, and RPCID showed the largest between-group difference and promising in-sample discrimination of case-control status. NVC-ocular associations are exploratory and warrant longitudinal, multicenter validation. Key Points • Analysis of this cross-sectional case-control sample demonstrated that inside-disc RPC (RPCID) vessel density was significantly lower in SLE (50.6 [43.4-55.7] vs 55.3 [44.3-59.7]; FDR-adjusted p < 0.001), indicating reduced peripapillary microcirculation. • RPCID had the biggest difference between groups. Our analysis also showed good discrimination, with an AUC of 0.804. • NVC indicators had significant correlations with certain OCTA/OCT metrics, such as DS (r =  - 0.384) and RNFL (r = 0.505). Since this was a cross-sectional study, these findings are preliminary and should be confirmed by future longitudinal research.