Retinal Vascular Assessment in Psoriasis: A Multicenter Study

Abstract

Purpose: To investigate the vascular status of the macula in psoriasis patients without history of ocular inflammation by Optical Coherence Tomography Angiography (OCTA).

Methods: This prospective cross-sectional multicenter study included 55 psoriasis patients and 55 control healthy subjects. A complete eye examination and 6 mm × 6 mm OCTA imaging were performed. Retinal vascular status was evaluated by analyzing vascular density (VD) of superficial vascular plexus (superficial wVD) and deep vascular plexuses (deep wVD) in a 6 mm × 6 mm area and in foveal (superficial fVD and deep fVD) and parafoveal sectors (superficial pVD and deep pVD). In addition, foveal thickness (FT) and foveal avascular zone (FAZ) and clinical variables, including best corrected visual acuity (BCVA), intraocular pressure and refractive condition, were collected.

Results: BCVA, intraocular pressure and refractive condition were comparable between cases and controls. OCTA imaging showed that superficial wVD and superficial pVD were lower in the psoriasis group in comparison with controls (p = 0.009 and p = 0.01, respectively). Similarly, deep wVD and pVD were lower in the psoriasis group in comparison with control subjects (p = 0.03 and p = 0.01, respectively). In a sub-analysis of 47 patients affected by psoriasis without psoriatic arthritis, lower values of wVD and pVD in both superficial and deep capillary plexuses were registered.

Conclusion: OCTA is a useful tool which provides data on vascular status of the retina in psoriasis with no ocular involvement. VD data may suggest that vascular changes may occur earlier than clinical onset of posterior inflammation.

Keywords: macula; optical coherence tomography angiography; psoriasis; retina; vascular changes.

FIGURE 1

Boxplots illustrating vascular density (VD) of the superficial capillary plexus in the psoriasis group and controls.

FIGURE 2

Boxplots illustrating vascular density (VD) of the deep capillary plexus in the psoriasis group and controls.

FIGURE 3

Optical coherence tomography angiography (OCTA) image of a control subject with a scan size of 6 × 6-mm. (A) Enface angiogram segmented at the level of the superficial capillary plexus (SCP). (B) Enface angiogram segmented at the level of the deep capillary plexus (DCP). (C) Foveal Avascular Zone (FAZ): area encircled by the inner yellow line; the outer yellow line is 300-μm far from the FAZ. (D) B-scan retinal image shows blood flow at the level of SCP, DCP, and choriocapillaris.

FIGURE 4

Optical coherence tomography angiography (OCTA) image of a patient affected by Psoriasis with a scan size of 6 × 6-mm. (A) Enface angiogram segmented at the level of the superficial capillary plexus (SCP). (B) Enface angiogram segmented at the level of the deep capillary plexus (DCP). (C) Foveal Avascular Zone (FAZ): area encircled by the inner yellow line; the outer yellow line is 300-μm far from the FAZ. (D) B-scan retinal image shows blood flow at the level of SCP, DCP, and choriocapillaris.