Optical coherence tomography angiography: a window on systemic sclerosis microangiopathy

Retinal vascular alterations were reported in patients with SSc suggesting a potential role for OCTA in the evaluation of SSc-related microangiopathy. The aim of the study is to evaluate the microangiopathic alterations in the retina of patients with SSc and to evaluate their correlation with the clinical manifestations of the disease and the capillaroscopic findings MATERIALS AND METHODS: This is a case-control study comparing SSc patients to healthy controls. OCTA acquisition consisted on scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of both the macula and the optic nerve, performed using Canon OCT. Vascular density (VD), vascular length density (VLD), foveal avascular zone (FAZ) and retinal thickness in the fovea and in the perifoveal region were obtained using dedicated software.

41 SSc patients (11 were VEDOSS) were compared with 20 healthy controls. SSc patients showed reduced VD and VLD values ​​in all areas evaluated both in the SCP and DCP (p < 0.001 for both). At the optic nerve level, both VD and VLD values ​​were reduced at the SCP (p < 0.001 for both) and DCP levels (p = 0.009 and p < 0.001). Retinal thickness in the parafoveal region was increased in SSc patients (p = 0.013) and correlated with blood flow at nailfold videocapillascopy (p = 0.030). VD and VLD at the foveal level in DCP were associated with the presence of avascular areas (p = 0.018 and p = 0.019) and neoangiogenesis (p = 0.023 and p = 0.025).

Ocular microangiopathy is present in scleroderma patients since the early stages of the disease and is correlated with capillaroscopic alterations.