Optical Coherence Tomography Angiography in Patients with Mixed Connective Tissue Disease

Background: Mixed connective tissue disease (MCTD) is a rare systemic autoimmune disease which presents with clinical features that overlap with at least two connective tissue disorders, including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM), dermatomyositis (DM), and rheumatoid arthritis (RA). It is characterized by the presence of anti-ribonucleoprotein (anti-U1RNP) antibodies. The mechanism of the vasculopathy associated with MCTD remains largely unknown. Optical coherence tomography angiography (OCTA) is a non-invasive imaging method of the microvasculature of the retina and choroid, providing the assessment of retinal perfusion. Objectives: The aim of the study was to evaluate the optical coherence tomography angiography (OCTA) parameters in patients with mixed connective tissue disease compared to healthy individuals. Methods: In this study, we compared the following parameters between patients with MCTD and healthy subjects: foveal avascular zone (FAZ), FAZ perimeter (PERIM), flow density (FD), choriocapillaris flow area (CCFA), outer retina flow area (ORFA), and foveal and parafoveal mean superficial and deep vessel density. Results: Parafoveal mean superficial vessel density and parafoveal mean deep vessel density were significantly lower in the MCTD group than in controls. The FAZ, FAZ PERIM, and FD values in the patients with MCTD were lower than in the control group and statistically significant for all parameters. Conclusions: The present study's findings suggest the presence of ocular vascular abnormalities in patients suffering from MCTD. These abnormalities are characterized by decreased retinal vessel density and lower choriocapillaris flow. The results of the study demonstrate the significant role of OCTA in the diagnosis and monitoring of microvascular changes in patients with MCTD.