Optic nerve head microcirculation on optical coherence tomography angiography is reduced in systemic lupus erythematosus and relates to nailfold videocapillaroscopy phenotypes: a cross-sectional case-control study

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.