Retinal microvascular dysfunction in systemic sclerosis

Background and aims: Systemic sclerosis (SSc) is a systemic autoimmune disease, characterized by widespread microvasculopathy and fibrosis. Vascular and endothelial cell changes appear to precede other features of SSc. Retinal vascular analysis is a new, easy-to-use tool for the assessment of retinal microvascular function. The primary aim of this study was to investigate whether retinal microcirculation is affected in patients with SSc compared to healthy controls.

Methods: Microvascular function was assessed non-invasively measuring flicker-light induced vasodilation of retinal arterioles (FIDart%). In addition, FID of retinal venules (FIDven%), central retinal arteriolar and venular equivalents (CRAE and CRVE), and measurements of flow-mediated vasodilation (FMD) of the brachial artery, pulse wave velocity (PWV) and pulse wave analysis were obtained. Patients with SSc were prospectively enrolled in the study (n = 40, mean age 56 ± 11 years, females 73 %) and compared with age- and sex-matched healthy controls (HC, n = 40; mean age 59 ± 15 years, females 73 %).

Results: Patients with SSc showed significant impairment of retinal microvascular function compared to age- and gender-matched HC (FIDart%: 2.23 ± 2.0 % vs. 3.1 ± 1.9 %, respectively, p = 0.04). FMD and PWV were not significantly different between the groups. Impaired retinal microvascular function was associated with SSc disease duration.

Conclusion: Our study shows a significant impairment of retinal microvascular function in patients with SSc. Because this association seems to be independent of CV risk and dependent on disease duration, retinal vessel analysis may have the potential to serve as a tool for risk assessment and prognosis.