Biomechanical Vitreous Alterations Detected by Strain Elastography Beyond Conventional B-Mode Ultrasound in Psoriatic Disease

Ocular involvement in psoriatic disease is often underrecognized, particularly when inflammation affects posterior segments and remains undetectable on routine examination or conventional imaging modalities. We report a 38-year-old woman with palmoplantar psoriasis and psoriatic arthritis, characterized by ultrasound-confirmed dactylitis and inflammatory left hip pain, receiving methotrexate and guselkumab. Disease activity was low (DAPSA 7.6; CRP 5.8 mg/L). She presented with increased intraocular pressure, progressive visual blurring, and headache of 8 months’ duration, without a previous history of uveitis. Multimodal imaging was performed, including slit-lamp examination, grayscale B-mode ocular ultrasound, optical coherence tomography (OCT), and strain elastography. Slit-lamp examination and grayscale B-mode ultrasound were unremarkable, with no detectable vitreous echoes (grade 0). OCT demonstrated preserved retinal architecture with subtle hyperreflective vitreous dots in the right eye, compatible with low-grade vitreous cellularity, while the left eye was unremarkable. In contrast, strain elastography revealed increased stiffness and marked heterogeneity within the vitreous and periocular tissues, suggesting biomechanical alterations not detected by conventional structural imaging. These findings suggest biomechanical alterations compatible with possible inflammatory tissue remodeling. In our patient, strain elastography revealed biomechanical heterogeneity that was not apparent on conventional B-mode ultrasound. These findings should be considered hypothesis-generating and warrant further investigation in prospective controlled studies.