Evaluation of the Optic Nerve Head Using Optical Coherence Tomography Angiography in Systemic Sclerosis Patients

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.

Zusammenfassung

Zweck Quantifizierung der radialen peripapillären Kapillargefäßdichte (RPK-GD) der Papille mittels optischer Kohärenztomografie-Angiografie (OCTA) bei Patienten mit systemischer Sklerose (SS), um einerseits zu bestimmen, ob es einen Unterschied zwischen den Werten der Patienten im Vergleich zu Kontrollgruppen gibt, und andererseits die Korrelationen der VD-Werte zu Krankheitsaktivität, Schadensrisiko und Drogenkonsum.

Methoden Die Stichprobe der Studie umfasste Patienten im Alter von 20 – 76 Jahren, bei denen SS diagnostiziert wurde, sowie eine Kontrollgruppe, welche der Stichprobe in den Verhältnissen von Alter und Geschlecht entsprach. Sie unterzogen sich in dieser Querschnittsbeobachtungsstudie einer Bildgebung mittels RTVue-XR AngioVue Optical Coherence Tomography Angiography.

Ergebnisse Insgesamt wurden 61 Augen von 61 konsekutiven SS-Patienten und 60 Augen von 60 Kontrollprobanden untersucht. Es gab keinen statistisch signifikanten Unterschied zwischen der Patienten- und Kontrollgruppe hinsichtlich der durchschnittlichen RNFL- (retinale Faserschicht) und RPC-VD-Messungen (p = 0,35 bzw. p = 0,25). Wenn der Titer der antinukleären Antikörper (ANA) anstieg, verringerten sich folgende Werte statistisch signifikant: RNFLüberlegen (p = 0,01, r = − 0,327), RPCganz (p = 0,029, r = 0,279), RPCperipapillär (p = 0,037, r = − 0,267), RPCüberlegen (p = 0,003, r = − 0,371); RPCinferior (p = 0,02, r = 0,297). Die RPC-Innenwerte waren bei Anti-Scl-70-positiven Patienten niedriger als bei negativen Anti-Scl-70-Patienten (p = 0,021). Der nasale RNFL-Wert (p = 0,03, r = − 0,278) nahm mit zunehmender Krankheitsdauer ab. Der RPC-Inside-Wert bei Patienten, die Hydroxychloroquin und Kalziumkanalblocker einnahmen, war höher als bei denen, die sie nicht einnahmen (p = 0,021, p = 0,027). Die Werte für RPCganz, RPCperipapillär und RPCnasal waren bei Kortikosteroid-Anwendern statistisch signifikant höher als bei denen, die keine Kortikosteroide anwendeten (p = 0,043; 0,030; 0,033).

Schlussfolgerung Es gab keinen signifikanten Unterschied zwischen der Patienten- und Kontrollgruppe hinsichtlich der durchschnittlichen RPC-VD-Messungen. Da dies jedoch die erste Studie ist, die die Gefäßdichte des Sehnervs bei SS-Patienten analysiert, ist es sinnvoll, in weiterführenden Untersuchungen die Veränderungen des Blutflusses des Sehnervs bei Sklerodermie mit OCTA zu berücksichtigen.

Conclusion Box

Already known:

• SS is a systemic disease with vasculopathy. According to prior research, although it affects various layers of the eye, the retina and choroid are primarily altered.

Newly described:

• There was no change in radial peripapillary capillary vessel density values measured by OCTA in SS disease. ANA titer, anti-scl-70 positivity, and the use of CS, HCQ, and calcium channel blockers in scleroderma patients affect RPC VD values.

Key words

diffuse systemic sclerosis - optical coherence tomography - optic nerve head

Schlüsselwörter

diffuse systemische Sklerose - optische Kohärenztomografie - Sehnervenkopf

Publication History

Received: 18 August 2022

Accepted: 04 November 2022

Accepted Manuscript online:
09 November 2022

Article published online:
16 February 2023

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