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Zamorano M, Redondo Marcos I, González-López JJ. Bilateral macular edema in sistemic sclerosis. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:252-255. [PMID: 38593979 DOI: 10.1016/j.oftale.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.
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Affiliation(s)
- M Zamorano
- Departamento de Oftalmología, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - I Redondo Marcos
- Departamento de Oftalmología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - J J González-López
- Departamento de Oftalmología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Paczwa K, Rerych M, Romanowska-Próchnicka K, Różycki R, Gołębiewska J. Ocular Manifestation in Systemic Sclerosis-A Literature Review. Life (Basel) 2024; 14:627. [PMID: 38792647 PMCID: PMC11122095 DOI: 10.3390/life14050627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease that affects more than 2 million people worldwide. It manifests through vasculopathy, an abnormal immunological response, and fibrosis leading to dysfunction of the multiple organs. The disease is categorized into two subtypes: limited cutaneous SSc and diffuse cutaneous SSc. Scleroderma can affect vital organs with respiratory, cardiac, renal, ocular, and dermatological complications. The ocular manifestations of the disease can occur in the anterior and posterior segments of the eye. Changes in the anterior segment related to the disease include eyelid skin remodeling, dry eye syndrome, and conjunctival abnormalities. The disease's impact on the posterior segment of the eye mostly causes pathologies in the retinal microcirculatory system and abnormalities in the optic nerve. This review provides detailed insights into ocular complications associated with scleroderma.
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Affiliation(s)
- Katarzyna Paczwa
- Opthalmology Department, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland; (K.P.); (M.R.); (R.R.); (J.G.)
| | - Magdalena Rerych
- Opthalmology Department, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland; (K.P.); (M.R.); (R.R.); (J.G.)
| | - Katarzyna Romanowska-Próchnicka
- Department and Polyclinic of Systemic Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Radosław Różycki
- Opthalmology Department, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland; (K.P.); (M.R.); (R.R.); (J.G.)
| | - Joanna Gołębiewska
- Opthalmology Department, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland; (K.P.); (M.R.); (R.R.); (J.G.)
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Foti R, Zeppieri M, Foti R, Visalli E, Amato G, Amato R, Dammino E, D’Esposito F, Gagliano C. Retinal Vascular Abnormalities and Clinical Parameters in Systemic Sclerosis. J Clin Med 2024; 13:2738. [PMID: 38792282 PMCID: PMC11122651 DOI: 10.3390/jcm13102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Systemic sclerosis is a complex autoimmune disease characterized by vasculopathy, fibrosis, and immune dysregulation. Ocular manifestations in these patients are increasingly recognized, suggesting potential correlations between systemic vascular abnormalities and ocular microvascular changes. Advancements in molecular immunology and imaging technology using ocular coherence tomography (OCT) have unveiled intricate pathways underlying possible disease pathogenesis. Understanding the interplay between retinal vascular abnormalities and molecular immunology parameters could provide insights into disease mechanisms and potential biomarkers. Purpose: The aim of this study was to investigate vascular abnormalities, detected with optical coherence tomography angiography (OCT-A), in systemic sclerosis patients and to find correlations between the severity of the disease detected with molecular immunology findings and OCT-A parameters. Methods: A group of 32 systemic sclerosis patients were compared with 9 healthy controls. Ganglion cell complex thickness (GCC), retina thickness of the fovea and parafovea, nerve fiber layer thickness (RNFL) and cup/disc area ratio were investigated using OCT. Vessel density (VD) of the superficial (SCP) and deep capillary plexus (DCP) of the whole macular area and ETDRS grid, size of the foveal avascular zone (FAZ) and vessel density of the radial peripapillary capillary plexus (RPCP) were evaluated using OCT-A. Modified Rodnan skin score (mRSS), capillaroscopy and disease duration were used to stage disease severity. Results: There was a statistically significant reduction in retina thickness of the fovea and parafovea, VD of the whole DCP, VD of the SCP and DCP in ETDRS grid in the patient group compared to controls (p < 0.001). The patients presented a significant enlargement of the FAZ (p 0.005). No significant correlation between OCT and OCT-A parameters and disease severity scores was found. Conclusions: OCT-A could represent a non-invasive tool to detect retinal microvascular damage in systemic sclerosis.
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Affiliation(s)
- Rosario Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Roberta Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (R.F.)
| | - Roberta Amato
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
| | - Edoardo Dammino
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
| | - Fabiana D’Esposito
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London NW1 5QH, UK
| | - Caterina Gagliano
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy (C.G.)
- Department of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
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Pieklarz B, Gińdzieńska-Sieśkiewicz E, Zawadzka I, Bagrowska M, Daniluk J, Palewski M, Zonenberg A, Kowal-Bielecka O, Konopińska J, Dmuchowska DA. Macular choroidal thickness, volume, and vascularity index in patients with systemic sclerosis. Graefes Arch Clin Exp Ophthalmol 2024; 262:1475-1487. [PMID: 38133798 PMCID: PMC11031445 DOI: 10.1007/s00417-023-06342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The aim of this study was to investigate choroidal parameters in patients with systemic sclerosis (SSc) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT) and to determine their relationships with clinical variables and ocular features. METHODS Thirty-three patients with SSc and 40 controls were enrolled. The groups did not differ with regard to age, sex, and axial length. The mean choroidal thickness and volume were obtained in each conventional Early Treatment of Diabetic Retinopathy Study grid subfield. The choroidal vascularity index (CVI), which provides a quantitative analysis of vasculature by calculating the proportion of the luminal area (LA) to the total choroidal area (TCA), was determined. RESULTS Lower choroidal thickness and volume were observed in the SSc group. The CVI was significantly higher in SSc patients, whereas the TCA, LA, and stromal area were significantly lower in the SSc group; however, the significant difference of the stromal component was more pronounced than that of the luminal component. Regression analyses did not identify any clinical factors associated with the CVI (except Ca-blocker use), central macular thickness, or volume. No significant differences in choroidal parameters were found within the SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) vs. limited cutaneous systemic sclerosis (lcSSc)), or between eyes stratified according to SSc pattern (early, active, or late) using nailfold capillaroscopy (p > 0.05 for all). CONCLUSION Our results, with notably higher CVI values, may shed new light on choroidal impairment in patients with SSc. Stromal involvement appeared to dominate the vascular component.
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Affiliation(s)
- Barbara Pieklarz
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland.
| | - Ewa Gińdzieńska-Sieśkiewicz
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Izabela Zawadzka
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Magdalena Bagrowska
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Joanna Daniluk
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Marcin Palewski
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Agnieszka Zonenberg
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Joanna Konopińska
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Diana Anna Dmuchowska
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland.
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Carlà MM, Gambini G, Caporossi T, Giannuzzi F, Boselli F, Crincoli E, Ripa M, Rizzo S. Ocular Involvement in Systemic Sclerosis: Updated Review and New Insights on Microvascular Impairment. Ocul Immunol Inflamm 2024:1-8. [PMID: 38466107 DOI: 10.1080/09273948.2024.2308030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Systemic sclerosis (SSc) is a chronic multisystemic disease characterized by immunological activation, diffuse vasculopathy, and generalized fibrosis exhibiting a variety of symptoms. A recognized precursor of SSc is Raynaud's phenomenon, which is part of the very early disease of systemic sclerosis (VEDOSS) in combination with nailfold videocapillaroscopy (NVC) impairment. The pathophysiology of ocular involvement, alterations in internal organs, and body integumentary system involvement in SSc patients are complicated and poorly understood, with multiple mechanisms presumptively working together. The most prevalent ocular symptoms of SSc are abnormalities of the eyelids and conjunctiva as well as dry eye syndrome, due to fibroblasts' dysfunction and inflammation of the ocular surface. In particular, lagophthalmos, blepharophimosis limitation of eyelid motion, eyelid telangiectasia, and rigidity or tightening of the lids may affect up to two-third of the patients. In addition, reduction in central corneal thickness, iris defects and higher rates of glaucoma were reported. In the first reports based on retinography or fluorescein angiography, about 50% of SSc patients showed signs of vascular disease: peripheral artery occlusion, thinning of retinal pigment epithelium and choroidal capillaries, ischemic areas surrounded by intraretinal extravasation and microaneurysms, and peripheral capillary non-perfusion. Successively, thanks to the advent of optical coherence tomography angiography (OCTA), several studies highlighted significant impairment of either the choriocapillaris and retinal vascular plexuses, also correlating with NVC involvement and skin disease, even in VEDOSS disease. Given the sensitivity of this technique, ocular micro-vasculopathy may act as a tool for early SSc identification and discriminate between disease stages.
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Affiliation(s)
- Matteo Mario Carlà
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
- Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Francesco Boselli
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Ripa
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Willesborough, UK
| | - Stanislao Rizzo
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
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Singh N, Al-Naamani N, Brown MB, Long GM, Thenappan T, Umar S, Ventetuolo CE, Lahm T. Extrapulmonary manifestations of pulmonary arterial hypertension. Expert Rev Respir Med 2024; 18:189-205. [PMID: 38801029 DOI: 10.1080/17476348.2024.2361037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Extrapulmonary manifestations of pulmonary arterial hypertension (PAH) may play a critical pathobiological role and a deeper understanding will advance insight into mechanisms and novel therapeutic targets. This manuscript reviews our understanding of extrapulmonary manifestations of PAH. AREAS COVERED A group of experts was assembled and a complimentary PubMed search performed (October 2023 - March 2024). Inflammation is observed throughout the central nervous system and attempts at manipulation are an encouraging step toward novel therapeutics. Retinal vascular imaging holds promise as a noninvasive method of detecting early disease and monitoring treatment responses. PAH patients have gut flora alterations and dysbiosis likely plays a role in systemic inflammation. Despite inconsistent observations, the roles of obesity, insulin resistance and dysregulated metabolism may be illuminated by deep phenotyping of body composition. Skeletal muscle dysfunction is perpetuated by metabolic dysfunction, inflammation, and hypoperfusion, but exercise training shows benefit. Renal, hepatic, and bone marrow abnormalities are observed in PAH and may represent both end-organ damage and disease modifiers. EXPERT OPINION Insights into systemic manifestations of PAH will illuminate disease mechanisms and novel therapeutic targets. Additional study is needed to understand whether extrapulmonary manifestations are a cause or effect of PAH and how manipulation may affect outcomes.
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Affiliation(s)
- Navneet Singh
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Nadine Al-Naamani
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Beth Brown
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary Marshall Long
- Department of Kinesiology, Health and Sport Sciences, University of Indianapolis, Indianapolis, IN, USA
| | - Thenappan Thenappan
- Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Soban Umar
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Corey E Ventetuolo
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Tim Lahm
- Department of Medicine, National Jewish Health, Denver, CO, USA
- Department of Medicine, University of Colorado, Aurora, CO, USA
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
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Cutolo CA, Cere A, Toma P, Cannavacciuolo T, Toma C, Balito S, Gerli V, Smith V, Sulli A, Paolino S, Gotelli E, Traverso CE, Nicolò M, Cutolo M, Hysa E. Peripheral and ocular microvascular alterations in systemic sclerosis: observations from capillaroscopic assessments, perfusion peripheral analysis, and optical coherence tomography angiography. Rheumatol Int 2024; 44:107-118. [PMID: 37978075 PMCID: PMC10766778 DOI: 10.1007/s00296-023-05495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
To investigate the correlations between finger microvascular morphology and function in patients with systemic sclerosis (SSc) and the status of ocular microcirculation, as detected by nailfold videocapillaroscopy (NVC), laser speckle contrast analysis (LASCA), and optical coherence tomography angiography (OCTA). The enrollment included 32 SSc patients, classified according to the 2013 ACR/EULAR criteria, and 27 sex- and age-matched healthy controls. The participants underwent comprehensive rheumatological and ophthalmological examinations, as well as NVC, LASCA, and OCTA analysis on the same day at a single center from March to October 2022. SSc patients receiving intravenous prostanoids cycles were assessed at least 1 month after infusion. Statistical analysis was conducted using Stata® 15.1. Significant direct correlations were observed between the mean capillary number (at NVC) and the mean perfusion of fingers (at LASCA) with the retinal and choroidal perfusion (at OCTA) (all p < 0.05). In addition, a significantly reduced retinal and choroidal perfusion was detected in SSc patients vs controls (all p < 0.05). Interestingly, diffuse cutaneous SSc (dcSSc) patients exhibited a lower choroidal perfusion (p = 0.03) but an increased choroidal thickness (CT) than limited cutaneous SSc patients (p < 0.001). CT was increased also in patients with positive Scl70 antibodies and with a history of digital ulcers directly correlating with disease duration (r = 0.67, p = 0.001). Finally, the combination of LASCA and OCTA parameters showed a significant discrimination capacity between SSc patients and controls, with an area under the curve of 0.80 [95% CI (0.74, 0.87)]. Peripheral microvascular damage is correlated with impaired ocular microcirculation in SSc. The increased choroidal thickness observed in dcSSc may be related to local sub-endothelial extracellular matrix deposition. The combined analysis of choroidal and fingertip perfusion offers preliminary insights that may complement traditional diagnostic methods for SSc.
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Affiliation(s)
- Carlo Alberto Cutolo
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Paola Toma
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Tommaso Cannavacciuolo
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Chiara Toma
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Serena Balito
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Veronica Gerli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Carlo Enrico Traverso
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Massimo Nicolò
- Ophthalmology Clinic DiNOGMI, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy.
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy.
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Huang H, Wang XY, Wei H, Kang M, Zou J, Ling Q, Xu SH, Huang H, Chen X, Wang YX, Shao Y, Yu Y. Retinal microvascular and microstructural alterations in the diagnosis of meibomian gland dysfunction in severely obese population: a new approach. Int J Ophthalmol 2023; 16:1977-1985. [PMID: 38111945 PMCID: PMC10700072 DOI: 10.18240/ijo.2023.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 12/20/2023] Open
Abstract
AIM To study retinal microvascular and microstructural alterations in meibomian gland dysfunction (MGD) in severely obese population using optical coherence tomography angiography (OCTA). METHODS Twelve MGD patients with severely obese population (PAT group; 24 eyes) and 12 healthy controls (HC group; 24 eyes) were recruited. OCTA images were segmented into five [superior (S), nasal (N), inferior (I), temporal (T), and central foveal (C)] or nine [inner superior (IS), outer superior (OS), inner nasal (IN), outer nasal (ON), inner inferior (II), outer inferior (OI), inner temporal (IT), outer temporal (OT), and C] subregions. The superficial vessel density (SVD), retinal thickness (RT), foveal avascular zone (FAZ) parameters, and retinal volume were measured. RESULTS Visual acuity was significantly different between two groups (0.8±0.17 in PAT group vs 0.2±0.06 in HC group). SVD was significantly lower in PATs in N, T, OS, IN, OT, and ON. The area under the receiver operating characteristic curve (AUC) for T was 0.961 [95% confidence interval (CI): 0.908 to 1.000], for OS was 0.962 (95%CI: 0.915 to 1.000). RT was significantly lower in PATs in IS, OS, OI, OT, ON, IT, IN, and II. AUC for OT was 0.935 (95%CI: 0.870 to 0.999), for IS was 0.915 (95% CI: 0.838 to 0.992). Angiography results showed significantly lower area and perimeter of FAZ, SVD of the inner retina and both retinal volume and the average volume thickness in the PAT group. CONCLUSION Vision may be affected in patients with MGD due to changes in retinal microvessels and microstructures. These changes detected by OCTA may be a potential marker for diagnosing MGD in severe obesity.
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Affiliation(s)
- Hai Huang
- Nanchang Aier Eye Hospital, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Yu Wang
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang 330006, Jiangxi Province, China
- The First Clinical Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hong Wei
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Min Kang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Jie Zou
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Qian Ling
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - San-Hua Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Hui Huang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Xu Chen
- Department of Ophthalmology and Visual Sciences, Maastricht University, Maastricht 6200MA, Limburg Province, Netherlands
| | - Yi-Xin Wang
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF244HQ, United Kingdom
| | - Yi Shao
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200433, China
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang 330006, Jiangxi Province, China
| | - Yao Yu
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang 330006, Jiangxi Province, China
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Takao M, Oishi A, Shimizu T, Kuwatsuka Y, Kitaoka T. Paracentral acute middle maculopathy in systemic sclerosis and subsequent branch retinal artery occlusion. Am J Ophthalmol Case Rep 2023; 32:101955. [PMID: 38020208 PMCID: PMC10663736 DOI: 10.1016/j.ajoc.2023.101955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose We report a case of systemic sclerosis-associated paracentral acute middle maculopathy (PAMM) in a young woman who subsequently developed branch retinal artery occlusion. Observations A 22-year-old woman presented with a paracentral scotoma. Optical coherence tomography (OCT) revealed bilateral paracentral acute middle maculopathy. Upon systemic examination, she was diagnosed with systemic sclerosis (SSc). She subsequently developed branch retinal artery occlusion despite vasodilator medications. After the prescription of aspirin, she did not experience a new event for one year. Conclusion and importance This case illustrates that SSc may affect the retinal vascular system and vision and cause PAMM. The optimal prophylaxis for patients with recurrent retinal events should be investigated in future studies.
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Affiliation(s)
- Miki Takao
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Ophthalmology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yutaka Kuwatsuka
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Güven YZ, Akay F, Akmaz B, Solmaz D, Gercik Ö, Akar S. Evaluation of retinal microvascular network in patients with systemic sclerosis: An optical cohorence tomography angiography study. Photodiagnosis Photodyn Ther 2023; 44:103774. [PMID: 37640203 DOI: 10.1016/j.pdpdt.2023.103774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To investigate the long-term effect of systemic sclerosis on the optic disk and retinal capillary network and to see whether the drugs used in the treatment of SSc affected optical coherence tomography angiography (OCTA) parameters. MATERIALS AND METHODS This cross-sectional case-control study included 40 systemic sclerosis patients and 40 healthy individuals. We included only one eye of each patient in the study. Macular layers and angiography scanning were performed with a Zeiss Cirrus 5000 OCTA system. Such values as macular thickness, retinal nerve fiber layer (RNFL), ganglion cell inner plexiform layer (GC-IPL) were obtained. For central vessel and perfusion density (VD, PD), central 6 mm were obtained and were evaluated by dividing it into 3 groups as inner, outer, and full. The FAZ was evaluated through 3 parameters: area, perimeter, circularity index. RESULTS Statistically significant difference was found between the groups in terms of the mean and foveal macular thickness values (p=0.008, p=0.033). Significant differences were also found between the two groups in terms of the VD and PD parameters in all regions except for 1 mm center (p<0.05). There were no significant differences in RNFL and GC-IPL values between two groups. Also, a positive correlation was observed between parapapillary perfusion density values and RNFL and GC-IPL thicknesses in SSc group. When the subgroups were compared in terms of vasodilator drug use, the subgroup using vasodilators was seen to have higher mean RNFL and inferior RNFL thicknesses (p=0.045 and p=0.035, respectively). In addition, there was a significant positive correlation between parapapillary VD and RNFL values in the SSc subgroup treated with vasodilators. CONCLUSIONS The results of this study demonstrate microvascular loss in individuals with systemic sclerosis, compared with healthy subjects. Also, it has been determined that OCTA is an important test for screening retinal and optic disk microvascular changes over time in cases of systemic sclerosis and may be used to evaluate the response to vasodilator drugs used in the treatment of SSc disease.
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Affiliation(s)
- Yusuf Ziya Güven
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey.
| | - Fahrettin Akay
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey
| | - Berkay Akmaz
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey
| | - Dilek Solmaz
- Department of Rheumatology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey
| | - Önay Gercik
- Department of Rheumatology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey
| | - Servet Akar
- Department of Rheumatology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey
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11
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Zirtiloglu S, Alikma MS, Acar OPA, Güven F, Icacan OC, Yigit FU. Evaluation of the Optic Nerve Head Using Optical Coherence Tomography Angiography in Systemic Sclerosis Patients. Klin Monbl Augenheilkd 2023; 240:1277-1283. [PMID: 36351552 DOI: 10.1055/a-1975-2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To quantify microvascular vessel density in the optic disc using optical coherence tomography angiography (OCTA) in patients with systemic sclerosis (SS); to determine whether there is a difference in values between patients and controls; and to correlate the OCTA measurements with disease activity, damage risk, and drug usage. METHODS Patients aged 20 - 76 years who were followed up after a diagnosis of SS and age- and gender-matched controls. The patients underwent RTVue-XR AngioVue OCTA imaging in this cross-sectional observational study. RESULTS A total of 61 eyes of 61 consecutive SS patients and 60 eyes of 60 controls were investigated. There was no statistically significant difference between the patients and control groups regarding the average RNFL (retinal fiber layer) and radial peripapillary capillary (RPC) vessel density (VD) measurements (p = 0.35, p = 0.25, respectively). As the antinuclear antibody (ANA) titer increased, RNFLsuperior (p = 0.01, r = - 0.327), RPCwhole (p = 0.029, r = 0.279), RPCperipapillary (p = 0.037, r = - 0.267), RPCsuperior (p = 0.003, r = - 0.371), and RPCinferior (p = 0.02, r = 0.297) values decreased with statistical significance. The RPCinside values were lower in anti-Scl-70-positive patients compared to patients negative for anti-Scl-70 (topoisomerase I) (p = 0.021). The RNFLnasal (p = 0.03, r = - 0.278) value decreased as the years of disease increased. The RPCinside value was higher in patients using hydroxychloroquine and calcium channel blockers than those who did not use them (p = 0.021 and p = 0.027, respectively). The RPCwhole, RPCperipapillary, and RPCnasal values were higher, with statistical significance in corticosteroid users than in those patients who did not use corticosteroids (p = 0.043, 0.030, and 0.033, respectively). CONCLUSION There was no significant difference between the patients and control groups regarding the average RPC VD measurements. However, since this is the first study to analyze optic disc vessel density in SS patients, optic nerve blood flow changes in scleroderma with OCTA could be studied.
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Affiliation(s)
- Sibel Zirtiloglu
- Department of Ophthalmology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Ozge Pinar Akarsu Acar
- Department of Ophthalmology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Güven
- Department of Ophthalmology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozan Cemal Icacan
- Department of Ophthalmology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fadime Ulviye Yigit
- Department of Ophthalmology, Istanbul Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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12
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Pieklarz B, Gińdzieńska-Sieśkiewicz E, Zawadzka I, Bagrowska M, Daniluk J, Sidorczuk P, Kowal-Bielecka O, Konopińska J, Dmuchowska DA. Peripapillary choroidal vascularity index and thickness in patients with systemic sclerosis. Front Med (Lausanne) 2023; 10:1273438. [PMID: 37915331 PMCID: PMC10617027 DOI: 10.3389/fmed.2023.1273438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Patients with systemic sclerosis (SSc) present an increased risk of developing glaucomatous optic neuropathy (GON). We investigated peripapillary choroidal parameters and peripapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) to determine the relationships of these factors with clinical variables. Methods A total of 33 patients with SSc were enrolled and compared to 40 controls. After obtaining circular scans around the optic disc, the global and quadrant peripapillary choroidal thickness (pCT) and RNFL thickness were measured. Additionally, the peripapillary choroidal vascularity index (pCVI), which allows for a quantitative analysis of the choroidal vasculature, was determined. Results No significant differences were found in pCT and RNFL thickness between patients with SSc and controls, or within SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) compared to limited cutaneous systemic sclerosis (lcSSc)) (p > 0.05). The pCVI was significantly lower in patients with SSc than in control subjects (64.25 ± 1.94 vs.65.73 ± 2.12, p < 0.001). Conclusion Our results suggest that the statistically significant decrease in pCVI in patients with SSc compared to the control group is probably due to a decrease in the vascular layer, which would partially explain an increased risk of GON in patients with SSc.
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Affiliation(s)
- Barbara Pieklarz
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | | | - Izabela Zawadzka
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | - Magdalena Bagrowska
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Joanna Daniluk
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Patryk Sidorczuk
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Joanna Konopińska
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
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13
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Kouwenberg CV, Spierings J, de Groot EL, de Boer JH, Kalinina Ayuso V. Involvement of the systemic microcirculation in pediatric uveitis. Pediatr Rheumatol Online J 2023; 21:109. [PMID: 37784087 PMCID: PMC10544362 DOI: 10.1186/s12969-023-00896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Pediatric uveitis is a severe inflammatory ocular condition that can lead to sight-threatening complications and can negatively impact quality of life. The retinal microcirculation is often affected in intermediate uveitis and panuveitis. Here, we examined the extraocular (i.e., systemic) microcirculation in pediatric uveitis cases and healthy controls using nailfold capillaroscopy (NFC). METHODS We performed NFC in 119 children with noninfectious uveitis and 25 healthy pediatric controls, and assessed the following parameters: capillary density (number of capillaries/mm), dilated capillaries (apex > 20 µm), avascular area, the presence of microhemorrhages, and capillary morphology. Differences in NFC parameters between cases and controls were calculated using regression analysis after adjusting for age and sex. RESULTS The mean (± SD) age of the patient group was 13.7 (± 3) years, with 56% females; 46%, 18%, and 36% of cases presented as anterior uveitis, intermediate uveitis, and panuveitis, respectively, with an overall mean disease duration of 4.7 (± 4.0) years. Compared to the control group, the pediatric uveitis cases had a significantly higher number of dilated capillaries/mm and a higher prevalence of ramified capillaries. Moreover, compared to the control group the intermediate uveitis cases had a significantly higher number of dilated capillaries, whereas the anterior uveitis cases had a lower capillary density and a higher prevalence of ramified capillaries. CONCLUSIONS Children with uveitis without systemic disease can present with changes in systemic microcirculation. These changes vary amongst the subtypes of uveitis.
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Affiliation(s)
- Carlyn V Kouwenberg
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evianne L de Groot
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Viera Kalinina Ayuso
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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14
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Asif MI, Kalra N, Sharma N, Jain N, Sharma M, Sinha R. Connective tissue disorders and eye: A review and recent updates. Indian J Ophthalmol 2023; 71:2385-2398. [PMID: 37322648 PMCID: PMC10418020 DOI: 10.4103/ijo.ijo_286_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 06/17/2023] Open
Abstract
Collagen vascular disorders (CVDs), also known as connective tissue diseases (CTDs), are a heterogeneous group of entities that affect the connective tissues and are capable of causing end-organ damage to multiple systems, primarily cardiopulmonary and musculoskeletal. However, the occurrence and severity are highly variable among patients. Ocular involvement occurs in a significant number of these disorders and may precede the onset of other extraocular features, thereby serving as an important marker in the diagnosis of these diseases. A timely and accurate diagnosis enables the management of complications. CTDs are primarily immune-mediated inflammatory diseases; however, classifications have encompassed heritable disorders affecting collagen-containing structures and disorders of vascular development. A review of literature published until 25 January 2022 and collected from various databases using the relevant keywords was conducted. All publications (original articles, review articles, as well as case reports) describing the ocular features in CTDs were studied in detail. The objective of this review is to recognize the common ophthalmic presentations of various autoimmune and heritable CTDs, distinguish them from overlapping diseases, elaborate on the prognosis and management of these varied eye presentations, and deliberate on their impact on other ophthalmic surgeries.
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Affiliation(s)
- Mohamed I. Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Jain
- The Cornea Institute, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohita Sharma
- Tirupati Eye Centre & Research Institute, Noida, India
| | - Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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15
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Fang X, Yu S, Peng Y, Huang B, Kang M, Xiong J, Luo T, Wu R, Shao Y. The Function of Retinal Thickness and Microvascular Alterations in the Diagnosis of Systemic Sclerosis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1805938. [PMID: 36874922 PMCID: PMC9977518 DOI: 10.1155/2023/1805938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 02/24/2023]
Abstract
In this study, we aim to investigate retinal thickness (RT) and superficial vascular density (SVD) differences between patients with systemic sclerosis (SSc) and healthy controls (HCs) by optical coherence tomography angiography (OCTA). Sixteen patients with a definitive SSc diagnosis without clinical signs of retinopathy and 16 normal control subjects were recruited. All individuals underwent OCTA scanning to assess macular RT and SVD. We divided each image into nine subregions as the early treatment diabetic retinopathy study (ETDRS). Visual acuity (VA) was considerably different between patients with SSc (32 eyes) and control subjects (32 eyes) (p < 0.001). Compared to the control group, individuals with SSc had decreased inner RT in inner superior, outer superior, outer temporal, inner temporal, center, and inner nasal regions (p < 0.05). Outer RT was decreased in the outer and inner temporal regions, and full RT was decreased in the regions of outer superior, inner superior, inner temporal, and outer temporal, in comparison to the control group (p < 0.05). Patients with SSc had significant reduction of SVD in the inner and outer of both superior and temporal, besides outer nasal regions than controls. (p < 0.05). Moreover, SVD was significantly associated with the outer temporal region of patients suffering from SSc (p < 0.05). Diagnostic Sensitivity of RT and SVD of Inner Superior Regions in SSc, as indicated by areas under curves of the Receiver Operating Characteristic (ROC), were 0.874 (95% CI: 0.786-0.962) and 0.827 (95% CI: 0.704-0.950), respectively. In conclusion, VA may be affected by RT variations inside the macula in patients with SSc. Measuring RT with OCTA could be a useful predictor of early diagnosis.
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Affiliation(s)
- Xia Fang
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Shujiao Yu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Yilin Peng
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Bozhi Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Min Kang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Jiangbiao Xiong
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Ting Luo
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Rui Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 Jiangxi Province, China
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Ataş F, Kaya M, Ayhan Z, Ozkan O, Birlik M. Evaluation of choroidal vascularity index in systemic sclerosis patients. Photodiagnosis Photodyn Ther 2023; 41:103297. [PMID: 36682429 DOI: 10.1016/j.pdpdt.2023.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the comparison of choroidal vascularity index (CVI) between patients with systemic sclerosis and healthy individuals. METHODS This study was designed prospective non-randomized cross-sectional study. Eighty-six eyes (43 patients) with limited cutaneous systemic sclerosis (lcSSc), 60 eyes (30 patients) with diffuse cutaneous systemic sclerosis (dcSSc) and 60 eyes (30 subjects) of age-and sex-matched healthy individuals were recruited. Subfoveal choroidal thickness, CVI and modified Rodnan skin score (mRSS) were evaluated. Enhanced depth imaging- optical coherence tomography scans were binarized using Niblack's autolocal threshold and CVI was determined as the luminal choroidal area/total choroidal area ratio. RESULTS The mean CCT values were 268.00±68.59 µm, 286.90±70.88 µm, 321.73±94.13 µm in lcSSc group, dcSSc group and control group, respectively. The mean CVI was 61.84±2.84% in lcSSc group, 54.62±5.84% in dcSSc group and 62.41±4.13% in control group (p=0.001). The mean CVI of the SSc patients was 58.91±5.58 and there was significant difference between control group (p<0.001). The mean mRSS was 3.84±2.50 in lcSSc group and 14.07±6.81 in dcSSc group (p<0.001). There was a statistically significant negative correlation between mRSS and CVI (r=-0.448, p<0.001) CONCLUSION: Choroidal vascularity index provides valuable information to monitor the disease progression and lower CVI values seem to be related to the disease severity in patients with systemic sclerosis.
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Affiliation(s)
- Ferdane Ataş
- Department of Ophthalmology, Çerkezköy State Hospital, Tekirdağ, Turkey.
| | - Mahmut Kaya
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ziya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ozlem Ozkan
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Merih Birlik
- Department of Rheumatology, Dokuz Eylul University, Izmir, Turkey
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Altered ocular microvasculature in patients with systemic sclerosis and very early disease of systemic sclerosis using optical coherence tomography angiography. Sci Rep 2022; 12:10990. [PMID: 35768479 PMCID: PMC9243093 DOI: 10.1038/s41598-022-14377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
The vascular hypothesis of systemic sclerosis (SSc) would predict microvascular alterations should also affect anatomical regions like ocular microvasculature. The objective of this study was to evaluate retinal and choriocapillary vessel density (VD) in patients with definite SSc and very early disease of systemic sclerosis (VEDOSS) using optical coherence tomography angiography (OCTA). 22 eyes of 22 patients and 22 eyes of 22 healthy subjects were included in this study. Patients were classified into patients with definite SSc and patients with VEDOSS. VD data of the superficial OCT angiogram (OCTA-SCP), deep OCT angiogram (OCTA-DCP) and choriocapillaris (OCTA-CC) were analysed. VD in the OCTA-SCP and OCTA-CC was lower in patients with SSc (p < 0.05). In VEDOSS patients, VD in the OCTA-CC was still reduced compared to controls (p < 0.05). Correlation analysis revealed a positive correlation between nailfold capillaroscopy and VD of OCTA-CC (Spearman correlation coefficient (rSp) 0.456, p < 0.05) and a negative correlation between skin score and VD of OCTA-SCP (p < 0.05). Ocular perfusion seems to be impaired in patients with SSc and even VEDOSS. VD correlated with disease severity. OCTA could be a new useful diagnostic and predictive parameter for monitoring patients with different stages of the disease.
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18
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Detection of microvascular changes in systemic sclerosis and other rheumatic diseases. Nat Rev Rheumatol 2021; 17:665-677. [PMID: 34561652 DOI: 10.1038/s41584-021-00685-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Morphological and functional analysis of the microcirculation are objective outcome measures that are recommended for use in the presence of clinical signs of altered peripheral blood flow (such as Raynaud phenomenon), which can occur in systemic sclerosis (SSc) and other autoimmune rheumatic diseases. Several advanced non-invasive tools are available for monitoring the microcirculation, including nailfold videocapillaroscopy, which is the best-studied and most commonly used method for distinguishing and quantifying microvascular morphological alterations in SSc. Nailfold videocapillaroscopy can also be used alongside laser Doppler techniques to assist in the early diagnosis and follow-up of patients with dermatomyositis or mixed connective tissue disease. Power Doppler ultrasonography, which has been used for many years to evaluate the vascularity of synovial tissue in rheumatoid arthritis, is another promising tool for the analysis of skin and nailbed capillary perfusion in other autoimmune rheumatic diseases. Other emerging methods include raster-scanning optoacoustic mesoscopy, which offers non-invasive high-resolution 3D visualization of capillaries and has been tested in psoriatic arthritis and SSc. The principle functions and operative characteristics of several non-invasive tools for analysing microvascular changes are outlined in this Review, and the clinical roles of validated or tested imaging methods are discussed for autoimmune rheumatic diseases.
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19
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Brinkmann MP, Kibele NX, Prasuhn M, Kakkassery V, Toro MD, Ranjbar M, Grisanti S, Becker M, Rommel F. Evaluating Retinal and Choroidal Perfusion Changes after Isometric and Dynamic Activity Using Optical Coherence Tomography Angiography. Diagnostics (Basel) 2021; 11:diagnostics11050808. [PMID: 33947000 PMCID: PMC8146969 DOI: 10.3390/diagnostics11050808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is a non-invasive tool for imaging and quantifying the retinal and choroidal perfusion state in vivo. This study aimed to evaluate the acute effects of isometric and dynamic exercise on retinal and choroidal sublayer perfusion using OCTA. A pilot study was conducted on young, healthy participants, each of whom performed a specific isometric exercise on the first day and a dynamic exercise the day after. At baseline and immediately after the exercise, heart rate (HR), mean arterial pressure (MAP), superficial capillary plexus perfusion (SCPP), deep capillary plexus perfusion (DCPP), choriocapillaris perfusion (CCP), Sattlers’s layer perfusion (SLP), and Haller’s layer perfusion (HLP) were recorded. A total of 34 eyes of 34 subjects with a mean age of 32.35 ± 7.87 years were included. HR as well as MAP increased significantly after both types of exercise. Both SCPP and DCPP did not show any significant alteration due to isometric or dynamic exercise. After performing dynamic exercise, CCP, SLP, as well as HLP significantly increased. Changes in MAP correlated significantly with changes in HLP after the dynamic activity. OCTA-based analysis in healthy adults following physical activity demonstrated a constant retinal perfusion, supporting the theory of autoregulatory mechanisms. Dynamic exercise, as opposed to isometric activity, significantly changed choroidal perfusion. OCTA imaging may represent a novel and sensitive tool to expand the diagnostic spectrum in the field of sports medicine.
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Affiliation(s)
- Max Philipp Brinkmann
- Department of Ophthalmology, Stadtspital Waid und Triemli Zürich, 8063 Zürich, Switzerland; (M.P.B.); (N.X.K.); (M.B.)
- Department of Ophthalmology, Klinikum Klagenfurt, A-9020 Klagenfurt, Austria
| | - Nikolas Xavier Kibele
- Department of Ophthalmology, Stadtspital Waid und Triemli Zürich, 8063 Zürich, Switzerland; (M.P.B.); (N.X.K.); (M.B.)
| | - Michelle Prasuhn
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (M.P.); (V.K.); (M.R.); (S.G.)
| | - Vinodh Kakkassery
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (M.P.); (V.K.); (M.R.); (S.G.)
| | - Mario Damiano Toro
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
- Correspondence: (M.D.T.); (F.R.); Tel.: +49-451-500-43952 (F.R.)
| | - Mahdy Ranjbar
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (M.P.); (V.K.); (M.R.); (S.G.)
| | - Salvatore Grisanti
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (M.P.); (V.K.); (M.R.); (S.G.)
| | - Matthias Becker
- Department of Ophthalmology, Stadtspital Waid und Triemli Zürich, 8063 Zürich, Switzerland; (M.P.B.); (N.X.K.); (M.B.)
- Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Felix Rommel
- Department of Ophthalmology, University of Lübeck, 23538 Lübeck, Germany; (M.P.); (V.K.); (M.R.); (S.G.)
- Correspondence: (M.D.T.); (F.R.); Tel.: +49-451-500-43952 (F.R.)
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