Assessment of retinal microvascular changes in systemic sclerosis using optical coherence tomography angiography: a case–control study

Background To evaluate retinal microvascular density in patients with systemic sclerosis (SSc) with no clinically evident retinal vascular changes and to correlate the results to disease severity and duration parameters. Patients and methods This case–control study included 21 SSc patients and 21 healthy controls. Patients were classified according to disease type as diffuse or localized. Vessel density data of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured using optical coherence tomography angiography. Results The superficial foveal vessel density was significantly lower in the SSc group ( P <0.001). The average parafoveal vessel densities in the SCP in the upper, lower, and temporal quadrants of the study group were significantly lower than those of the controls ( P <0.001, P =0.004, and P <0.001, respectively). Regarding the vessel density in the perifoveal area of the SCP, it was only significantly different in the lower quadrant ( P <0.001). The foveal vessel density of the SSc group in the DCP was significantly lower than that of the control group ( P <0.001). The average parafoveal vessel densities of the DCP in the upper, lower, nasal, and temporal quadrants were significantly lower in the SSc group than in the control group ( P <0.001). The average upper, lower, nasal, and temporal fields in the perifoveal area of the DCP were significantly lower in the SSc group than in the control group ( P <0.001). Conclusion SSc patients show significant retinal microvascular changes without any clinical signs of retinopathy. These microvascular changes correlate significantly with the severity and partly with duration of the disease. Optical coherence tomography angiography could be used as a valuable objective biomarker for the assessment of microvascular effects in SSc patients.