Article
Evaluation of therapy-induced changes in subfoveal choroidal thickness and choriocapillary perfusion in systemic sclerosis under IIoprost-infusion therapy using optical coherence tomography and angiography
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Published: | February 5, 2019 |
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Background: Systemic sclerosis (SSc) is characterized by endothelial dysfunction, vasculopathy, inflammation, fibrosis and – as a distinctive feature – thickening of the skin (scleroderma) through accumulation of collagen. Vascular injury is the underlying cause of Raynaud’s phenomenon, nailfold capillary changes and digital ulcers. Notably, the choroid is also known to be involved as a result of vascular dysregulation. Iloprost, a synthetic analogue of prostacyclin PGI2, is used as vasodilatatory and immune-modulatory therapy protecting from digital ulceration and painful acral hypoperfusion. While clinical effects have been reported, an objectifiable method of measurement of iloprost-induced vascular-changes is not available.
Methods: This study examined the changes in subfoveal choroidal thickness (SFCT) and choriocapillary perfusion (CCP) in 13 patients with systemic sclerosis with progressive scleroderma (mRSS: 8.077±6.788) and acral hypoperfusion (Raynaud’s phenomenon 13/13; history of digital ulceration 10/13) before and after 4 to 5-days iloprost-infusion therapy up to 40μg/6h. Healthy individuals served as controls. Thickness and perfusion measurements were performed using optical coherence tomography and angiography (OCT-A; Canon, Tokio Japan).
Results: Compared to healthy controls, the SFCT and CCP were significantly reduced in patients with SSc indicating a widespread vascular injury. Iloprost-therapy resulted in an increased SFCT and CCP.
Conclusion: Reduction of subfoveal choroidal thickness is indicative of foveal vascular injury. The findings of our study suggest usage of OCT-A as a clinical tool for assessing disease activity and therapeutic effects in SSc.