Subclinical Retinal Perfusion Changes in Patients with Takayasu Arteritis

To investigate subclinical ocular alterations in patients with Takayasu arteritis (TA) without Takayasu retinopathy (TR) using optical coherence tomography (OCT) and OCT-angiography (OCTA). In this cross-sectional study, 53 TA patients fulfilling the 2022 EULAR criteria and 53 age- and sex-matched controls underwent comprehensive ophthalmologic evaluation, including multimodal imaging. Structural parameters (retinal and choroidal thickness) and vascular parameters [foveal avascular zone (FAZ), vessel density of superficial (SCP) and deep (DCP) capillary plexuses, and choriocapillaris perfusion] were quantified. Associations between vascular metrics and systemic manifestations were analyzed. No patient showed clinical signs of TR. Compared with controls, TA patients had significantly greater subfoveal choroidal thickness (361 ± 64 μm vs 307 ± 70 μm, p < 0.001) and FAZ area (0.38 ± 0.19 mm2 vs 0.30 ± 0.11 mm2, p = 0.044) and reduced SCP vessel density (35.09 ± 2.98% vs 36.75 ± 2.43%, p = 0.002). DCP vessel density and choriocapillaris perfusion did not differ significantly. In exploratory analyses, larger FAZ area was associated with arthritis and dizziness, while associations with headache, carotid artery involvement and limb claudication did not reach statistical significance. Choroidal thickness was greater in patients receiving glucocorticoids. TA patients without TR showed subclinical retinal and choroidal alterations, namely lower SCP vessel density, a larger FAZ, and greater subfoveal choroidal thickness than matched controls. These cross-sectional findings indicate associations rather than causal relationships, and their clinical relevance requires confirmation in larger longitudinal studies. OCTA may help detect subclinical ocular involvement in TA, but its role as a biomarker remains to be established.