Güven Yusuf Ziya, Akay Fahrettin, Akmaz Berkay, Solmaz Dilek, Gercik Önay, Akar Servet
Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey.
Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, İzmir, Turkey.
Photodiagnosis Photodyn Ther. 2023 Dec;44:103774. doi: 10.1016/j.pdpdt.2023.103774. Epub 2023 Aug 26.
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.
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.
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.
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.
研究系统性硬化症对视盘和视网膜毛细血管网络的长期影响，并观察用于治疗系统性硬化症（SSc）的药物是否会影响光学相干断层扫描血管造影（OCTA）参数。
这项横断面病例对照研究纳入了40例系统性硬化症患者和40名健康个体。研究中仅纳入了每位患者的一只眼睛。使用蔡司Cirrus 5000 OCTA系统进行黄斑层和血管造影扫描。获取黄斑厚度、视网膜神经纤维层（RNFL）、神经节细胞内丛状层（GC-IPL）等数值。对于中央血管和灌注密度（VD，PD），获取中央6毫米区域的数据，并将其分为内、外、全三个区域进行评估。通过面积、周长、圆形度指数这三个参数评估黄斑无血管区（FAZ）。
两组在平均黄斑厚度和中心凹黄斑厚度值方面存在统计学显著差异（p = 0.008，p = 0.033）。除1毫米中心区域外，两组在所有区域的VD和PD参数方面也存在显著差异（p < 0.05）。两组之间的RNFL和GC-IPL值无显著差异。此外，SSc组视盘周围灌注密度值与RNFL和GC-IPL厚度之间存在正相关。在比较使用血管扩张剂药物的亚组时，发现使用血管扩张剂的亚组平均RNFL较高，RNFL厚度较低（分别为p = 0.045和p = 0.035）。此外，在接受血管扩张剂治疗的SSc亚组中，视盘周围VD与RNFL值之间存在显著正相关。
本研究结果表明，与健康受试者相比，系统性硬化症患者存在微血管丢失。此外，已确定OCTA是一种重要的检查方法，可用于筛查系统性硬化症患者随时间变化的视网膜和视盘微血管变化，并可用于评估治疗SSc疾病所用血管扩张剂药物的疗效。
