Evaluation of Macular Ganglion Cell-inner Plexiform Layer and Choroid in Psoriasis Patients Using Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography

Alterations in Retinal Vascularity in Severe Psoriasis

PURPOSE

To evaluate the changes in retinal vascularity in patients with severe psoriasis.

MATERIALS AND METHODS

Patients with severe psoriasis [psoriasis area-severity index (PASI) >10] who did not get any systemic treatment in the last year and do not have any ocular diseases were included. All patients underwent detailed ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA). Vessel densities (VD) of Superficial (SCP) and deep (DCP) capillary plexus, foveal avascular zone (FAZ) diameter, central retinal thickness (CRT) were analyzed and compared with age-sex matched healthy adults.

RESULTS

Fifty-three patients (13 F, 40 M) and 56 controls (16 F, 40 M) were included in the study. VD of SCP (50.4%±3.9 vs. 51.4%±3.2) and DCP (52.6%±6.4 vs. 55.4%±5.7) were lower in psoriasis group compared to controls (p < .05). Presence of psoriatic arthritis was related with an increased CRT (p = .000), larger FAZ and decreased foveal VD in SCP (p = .01, p = .02, respectively).

CONCLUSION

Severe psoriasis causes a decrease in retinal blood flow and presence of psoriatic arthritis is related with decreased foveal VD.

Evaluation of the retinal nerve fiber layer and choroidal thickness with optical coherence tomography in patients with psoriasis

BACKGROUND

To evaluate the retinal nerve fiber layer (RNFL), central retinal thickness (CRT), and choroidal thickness (CT) in patients with psoriasis.

METHODS

The study included 43 patients diagnosed with psoriasis not receiving systemic treatment and 41 healthy volunteers. Spectral domain optical coherence tomography was used for retinal and choroidal thickness measurements. The mean RNFL, quadrant RNFL (superior, inferior, nasal, temporal), and CRT values were recorded. The choroidal thickness measurements were taken from the subfoveal area, towards the temporal and nasal directions from the fovea at distances of 500, 1000, and 1500 µm.

RESULTS

The RNFL was determined to be thinner in the superior quadrant (p=0.025), and the CT was thicker at all the measurement points (p < 0.05) in the patients with psoriasis. The CRT values were similar in both groups (p > 0.05). No correlation was determined between the parameters measured and disease duration or severity.

CONCLUSIONS

Thinning of the RNFL and increased CT may be a sign of choroidal microvascular changes and ganglion cell damage due to psoriasis.

Retinal vascular assessment in psoriatic patients with and without metabolic syndrome using optical coherence tomography angiography

To evaluate the retinal vasculature in psoriasis patients and detect if metabolic syndrome is an additional risk factor. This cross-sectional analytic study was carried out on 80 eyes of 80 subjects; 28 eyes with psoriasis only (PS group), 12 eyes with additional metabolic syndrome to psoriasis (PMS group) and 40 eyes healthy controls (HS). The retinal capillary plexuses were evaluated by OCTA. The disease activity was evaluated by the Psoriasis Area and Severity Index (PASI) score and extent. The superficial capillary plexus (SCP) vascular density was significantly lower in PS group than HS while in PMS it was significantly lower only in whole image and superior and temporal perifoveal areas (p-value = 0.020, 0.030, 0.001 respectively). The changes correlated with the disease duration. The vascular density of the deep capillary plexus (DCP) was significantly lower in both PS and PMS groups (p-value < 0.001). Psoriatic patients are at a higher risk of developing retinal vascular complications even without evident clinical ocular disease. It was noted that the presence of metabolic syndrome contributes as an additional risk factor in possible visual loss secondary to ischemic changes that are likely to start in the DCP and progress to involve all levels.

Comparison of the effects of psoriasis and vitiligo on retina pigment epithelium thickness

PURPOSE

The purpose of the study was to compare Retinal Pigment Epithelium (RPE) thickness in patients with Psoriasis and Vitiligo.

MATERIALS AND METHODS

The right eyes of 67 Psoriasis and 65 Vitiligo patients and 71 healthy individuals were included in the study. The RPE thicknesses were analyzed with the Spectral Domain Optical Coherence Tomography after routine ophthalmological examinations (SD-OCT).

RESULTS

No statistically significant differences were detected when Psoriasis and Vitiligo patients were compared in terms of RPE levels (p= 0.033). When compared with the control group, no significant differences were found with Psoriasis patients, but a significant difference was detected with Vitiligo patients (p=0.515, p=0.001, respectively).

CONCLUSION

Although no changes were detected in RPE in Psoriasis, the decreased RPE thickness in Vitiligo may be an indicator of the effect of melanin loss on the posterior segment of the eye in Vitiligo. For this reason, measurement of RPE thickness with OCT can help in detecting the damage in Vitiligo patients.

Identifying and Treating Ocular Manifestations in Psoriasis

Psoriasis is a chronic immune-mediated inflammatory skin condition that commonly presents with red, thickened, and scaling plaques. Given the prominent cutaneous manifestations of psoriasis, more subtle ophthalmic findings of the disease may initially go undetected, with the potential for significant ocular morbidity. Associated ocular disease can involve nearly any structure of the eye, with the eyelids most commonly being affected, resulting in relatively common signs and symptoms of ocular surface discomfort. The presence of intraocular inflammation (i.e., uveitis) or retinal involvement carry a heightened risk of vision loss, and are often more difficult to diagnose outside of the ophthalmology clinic. Early detection and treatment of ocular disease can limit morbidity and are critical to the management of these patients, which requires coordination of care between dermatologists and ophthalmologists. The objective of this article was to review the most common ocular conditions that affect psoriatic patients, when to consider referral to an ophthalmologist, and to summarize the adverse ocular effects of current psoriasis treatments.

Assessment of central retinal thickness, choroidal thickness, and retinal nerve fiber layer in psoriasis: a spectral-domain optical coherence tomography study

Background

This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT).

Methods

This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 μm from the foveal center.

Results

The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40–9.00). No significant differences were found in subfoveal (p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group (p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL (p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters (p > 0.05).

Conclusions

No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.

Retinal nerve fibre layer thickness and choroidal thickness: An evaluation in psoriasis patients

BACKGROUND/OBJECTIVES

To conduct a comparative study of retinal nerve fibre layer (RNFL) thickness and choroidal thickness of psoriasis patients and healthy volunteers.

METHODS

This study included 35 severe psoriasis patients, 35 mild psoriasis patients and 35 healthy individuals. RNFL and choroidal thickness analysis were performed by spectral field optical coherence tomography (SD-OCT). Only patients with psoriasis vulgaris who have not used systemic therapy for the last 3 months were included in the study.

RESULTS

In the severe psoriasis group, the RSLT thickness was found to be statistically significantly thinner and the choroid thickness was thicker than the mild psoriasis and control group (P < .001). There was no significant difference in terms of RNLF and choroid thickness compared to mild psoriasis and the control group (P > .05). The correlation between length of the disease duration, RNFL and choroidal thickness was not significant (P > 0,05).

CONCLUSION

The increase in choroidal thickness was found to be significant, while with respect to RNFL thickness, a decrease was evident, a possible indicator of damage to microvascular structures in the choroid and ganglion cells, especially in patients with severe psoriasis. Therefore, choroidal and RSLT thickness measurement with OCT device can assist in the detection of damage to psoriasis.

Retinal Vascular Assessment in Psoriasis: A Multicenter Study

Purpose

To investigate the vascular status of the macula in psoriasis patients without history of ocular inflammation by Optical Coherence Tomography Angiography (OCTA).

Methods

This prospective cross-sectional multicenter study included 55 psoriasis patients and 55 control healthy subjects. A complete eye examination and 6 mm × 6 mm OCTA imaging were performed. Retinal vascular status was evaluated by analyzing vascular density (VD) of superficial vascular plexus (superficial wVD) and deep vascular plexuses (deep wVD) in a 6 mm × 6 mm area and in foveal (superficial fVD and deep fVD) and parafoveal sectors (superficial pVD and deep pVD). In addition, foveal thickness (FT) and foveal avascular zone (FAZ) and clinical variables, including best corrected visual acuity (BCVA), intraocular pressure and refractive condition, were collected.

Results

BCVA, intraocular pressure and refractive condition were comparable between cases and controls. OCTA imaging showed that superficial wVD and superficial pVD were lower in the psoriasis group in comparison with controls (p = 0.009 and p = 0.01, respectively). Similarly, deep wVD and pVD were lower in the psoriasis group in comparison with control subjects (p = 0.03 and p = 0.01, respectively). In a sub-analysis of 47 patients affected by psoriasis without psoriatic arthritis, lower values of wVD and pVD in both superficial and deep capillary plexuses were registered.

Conclusion

OCTA is a useful tool which provides data on vascular status of the retina in psoriasis with no ocular involvement. VD data may suggest that vascular changes may occur earlier than clinical onset of posterior inflammation.

Optical Coherence Tomography Angiography for Evaluation of Retinal Vascular Changes in Patients with Psoriasis according to Disease Severity

OBJECTIVES

To investigate foveal avascular zone (FAZ) area and retinal vascular density (VD) in patients with psoriasis according to disease severity using optical coherence tomography angiography (OCTA).

METHODS

Twenty-seven patients with mild psoriasis (Group 1), 28 with moderate to severe psoriasis (Group 2) and 30 healthy controls (Group 3) were evaluated with OCTA. Foveal and parafoveal VD and FAZ area were measured and compared.

RESULTS

FAZ values were significantly higher in Group 2 (0.20 ± 0.1, 0.31 ± 0.07, 0.20 ± 0.09; P < .001, respectively.). The mean VD value were significantly lower in the deep capillary plexus in parafoveal area in Group 2 (35.5 ± 8.7, 28.7 ± 4.6, 35.0 ± 3.5; P < .001, respectively.). These changes showed significant correlation with Psoriasis Area and Severity Index (PASI) scores of patients.

CONCLUSIONS

Our results suggest that OCTA may have a future role as alert of potentially more severe disease in cases clinically classified as mild disease.

Role of CD 20+ T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis

OBJECTIVE

To assess the role of CD3⁺ CD20⁺ CD4^- CD8^- double-negative (DN) or CD3⁺CD20⁺ CD4/CD8⁺ T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis.

DESIGN

A total of 76 patients (57.6 ± 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1α, IL1β, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFNγ, TNF-α, GMCSF.

RESULTS

The CD3⁺CD4⁺/CD8⁺CD20⁺CD56^- T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler's layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3⁺CD4⁺/CD8⁺CD20⁺CD56^- T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller's layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13).

CONCLUSION

Our findings demonstrated that CD20⁺ T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.

Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: A review

To identify the risk of relapse and subclinical inflammatory stages of systemic autoimmune diseases, new tools are needed. In the recent years, choroidal thickness and retinal thickness measured with ocular coherence tomography (OCT) have been proposed as an inflammatory marker for different systemic diseases, especially for conditions with a vascular component. Our aim in this article is to review the literature regarding the role of choroidal and retinal thickness as a potential inflammatory marker in systemic autoimmune and inflammatory diseases measured by OCT. Current literature suggests that the choroid of patients thickens in active phases of inflammatory diseases with vascular involvement. This pattern is observed in lupus, systemic sclerosis, Behçet disease, spondylitis, and familial Mediterranean fever. Choroidal thickness may decrease with biological treatments, along with systemic inflammation. Repeated flares and long-term disease, however, may thin the choroid, as a result of prolonged insult to the microvasculature and subsequent atrophy. Less is known about the effect of these diseases on retinal thickness. In summary, choroidal and retinal thickness measured by OCT may be promising markers for inflammation in systemic autoimmune and inflammatory diseases; however, more studies are warranted before generalizing choroidal thickness measurements by OCT as a marker for disease activity. The role of retinal thickness is more unclear due to a lack of studies in this field.

Pachychoroid Pigment Epitheliopathy and Choroidal Thickness Changes in Coeliac Disease

Purpose

To evaluate choroidal thickness in patients with coeliac disease (CD) using spectral domain optical coherence tomography (SD-OCT) and to compare the results to normal eyes.

Methods

Seventy patients with CD and 70 healthy controls were included in this prospective, comparative study. All participants underwent a complete ophthalmologic evaluation and SD-OCT. Subfoveal, nasal (nasal distance to fovea 500 μm, 1000 μm, and 1500 μm), and temporal (temporal distance to fovea 500 μm, 1000 μm, and 1500 μm) choroidal thickness measurements were performed using SD-OCT.

Results

There were no significant differences in sex, ages, and axial lengths between the groups (p=1.0, p=0.601, p=0.314, respectively). The mean choroidal thickness measurements at all predefined measurement point areas were higher in the coeliac group than in the healthy controls (p < 0.001). Of all patients with coeliac disease (70 eyes of 70 patients), 64 eyes (84.2%) had uncomplicated pachychoroid (UCP), one eye had pachychoroid pigment epitheliopathy (PPE), and five eyes in the UCP group had PPE in fellow eyes.

Conclusion

It is probable that systemic inflammation in coeliac patients causes the enlargement of choroidal vessels and increasing choroidal thickness. PPE, which is believed to be the precursor of central serous chorioretinopathy, can be observed in coeliac patients.

Evaluation of ocular findings in patients with lichen planus

Introduction

Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology.

Aim

To evaluate the tear functions and the retinal and choroidal thickness (CT) in patients with LP.

Material and methods

In total, 33 patients and 30 healthy controls were enrolled. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test (with anesthesia), tear break-up time (TBUT) test, intraocular pressure (IOP), axial length (AL), and central corneal thickness (CCT). The measurements of retinal thickness (RT) and CT were obtained by spectral domain optical coherence tomography.

Results

No significant difference was observed between the groups in IOP, AL, CCT, or RT (p > 0.05 in each group). There was a significant difference in the Schirmer 1 test, TBUT, and OSDI questionnaire (p < 0.05 in each group). Choroidal thickness in LP patients was thinner than that in the controls (p = 0.001 in each location). There was a moderate negative correlation between the disease duration and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.426, r = –0.555, r = –0.637; p = 0.001, p = 0.001, p = 0.001, respectively). There was a moderate negative correlation between the oral mucosal involvement and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.345, r = –0.392, r = –0.467; p = 0.006, p = 0.001, p = 0.001, respectively). There was a positive correlation between disease duration, oral mucosal involvement and OSDI score (r = 0.717, r = 0.345; p = 0.001, p = 0.006, respectively).

Conclusions

Lichen planus may influence tear function tests and may cause dry eye. Patients with LP had lower CT values than healthy controls. Further studies are needed to clarify the effect of LP on the eyes.