title: Choroidal impairment and macular thinning in patients with systemic sclerosis: the acute study.
abstract: Raynaud's phenomenon (RP) is a reversible vasospastic response of the extremities to cold or emotion, and can be the first manifestation or may be present before the development of an overt systemic sclerosis (SSc). The disturbance of the balance between vasodilation and vasoconstriction is not limited to the peripheral microcirculation of the skin, but it is also observed in other organs, such as the choroidal plexus of the eye. We aimed to examine the choroidal thickness (CT), the macular thickness and ganglion cell complex (GCC) average in thirty consecutive patients, without visual symptoms, classified as primary RP (pRP), RP secondary to suspected SSc, and overt SSc. All the patients underwent rheumatologic and ophthalmologic examination, capillaroscopy, test for anti-nuclear antibodies, anti-dsDNA, and anti-extractable nuclear antigens. Ophthalmologic examination included: best corrected visual acuity; slit lamp biomicroscopy; intraocular pressure measurements, fundus examination, and Spectral Domain-Optical Coherence Tomography (SD-OCT) with enhanced depth imaging scan system. Twenty-seven healthy subjects similar for gender and age were analyzed. In pRP, CT was significantly thinner than controls in the outer nasal and temporal regions. In secondary RP, the inner and outer nasal areas were significantly thinner than controls. In SSc, the central, inner inferior, inner nasal, inner superior, outer temporal, outer inferior, and outer nasal regions were significantly thinner than controls. A decreasing trend of central foveal thickness was noted. All the patients had GCC average significantly lower than controls. A thinning of choroidal and macular thickness, as well as of GCC was observed in patients with pRP and becomes more severe and extensive in RP secondary to suspected SSc and overt SSc. To our knowledge, this is the first study to analyze the choroidal features using SD-OCT in RP. These data may be clinically useful in suggesting an early involvement of ocular microcirculation with significant reduction of choroidal perfusion.
authors.affiliation: Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Piazza cardinal Ferrari 1, Milano, Italy. Electronic address: francesca.ingegnoli@unimi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ingegnoli
authors.affiliation: Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Piazza cardinal Ferrari 1, Milano, Italy. Electronic address: roberta.gualtierotti@unimi.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Gualtierotti
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, Milano, Italy. Electronic address: pierro.luisa@hsr.it.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pierro
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, Milano, Italy. Electronic address: c.delturco@studenti.unisr.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Del Turco
authors.affiliation: Ocular immunology and Uveitis Service, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, Milano, Italy. Electronic address: miserocchi.elisabetta@hsr.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Miserocchi
authors.affiliation: Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Piazza cardinal Ferrari 1, Milano, Italy. Electronic address: invidendus@gmail.com.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Schioppo
authors.affiliation: Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Piazza cardinal Ferrari 1, Milano, Italy. Electronic address: pierluigi.meroni@unimi.it.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Meroni
mesh_terms: D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002829:Choroid / Q000473:pathology* / Q000503:physiopathology; D015862:Choroid Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008266:Macula Lutea / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011928:Raynaud Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012165:Retinal Ganglion Cells / Q000473:pathology; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D066167:Slit Lamp; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D015415:Biomarkers
keywords: Choroid; Connective tissue disease; Eye; Macula; Microcirculation; Raynaud's phenomenon; SD-OCT; Screening; Systemic sclerosis